Inhalation Sedation: IACSD, My own course and the future.

Well the dust is just thinking about settling following the publication of the new

 Dental Sedation Guidelines by the IACSD 

There will be consequences to the profession and patients alike which I have no doubt will have all been forseen. Chris and I attended the DSTG in London on Tuesday 19th April.

The meeting opened with David Craig , DSTG rep on the IACSD (Intercollegiate Advisory Committee for Sedation in Dentistry.) summarizing the report.

These are guidelines not legal requirements but ...

Please note there are many grey areas still I feel and indications that registrants involved "should" do x,y,or z .  There are some "Musts" also (see below)  

Please read the guidelines yourself.

 Published on April 22nd 2015 

(To be reviewed in 2018)

These guidelines cover every form of Dental Conscious Sedation for every group of patients, wherever it provided and by whomever and also lays down requirements for the educators and mentors with specific curricula for each dental professional involved.  Dentists, Therapists, Hygienists and Dental Nurses, whether already offering dental sedation but also those considering becoming involved must read the Report. 

There are 116 pages in all but excluding the useful appendices and the introduction that makes 100-odd pages:

BUT only some related to Inhalation Sedation.

My interest lies specifically in the field of Inhalation Sedation (IS)

  A summary regarding Inhalation Sedation only.

So for IS - This is not definitive but after several readings and much discussion with colleagues and an IACSD committee member this is where I am so far.

Existing users and their teams

Carry on Sedating!

You are all being "Grandfathered" through under "Transitional Arrangements" as long you started to use IS or were enrolled on a course or perhaps are mid-way through being mentored through their first 10 cases before April 22nd.

What if I only carry out a few sedations?

Page 3

"Those using a technique of conscious sedation infrequently should consider whether it is in the best interests of patients for them to continue to use it."

Note the report does not define what "Infrequently" means and even then it says -Those people "should" (not must)  consider ...IT DOES NOT say " must give up.  
So you may duly consider matters and provided you keep up with the other recommendations and I would suggest put this in writing, reflectively, you may decide to continue anyway. 
However later on P86 it says"
P 86 
"practitioners not regularly practising a technique must consider the need for mentoring and/or retraining." Again what you MUST do is consider it not necessarily undertake this.
Much would seem to depend on a self-assessment of the registrants competence, perhaps the number of cases over the number years. Again no guidance is given.

BUT 

1. All involved must work towards doing 12 hrs every 5 yrs vCPD (no change there)
2. Assisting RDNs must work towards gaining their Certificate in Dental Sedation Nursing ( CDSN) offered by NEBDN or equivalent.  RDNs do not have to have the certificate now to continue what they have already been doing. NO date was set as to when they must be certificated by.  It was estimated that 90% of assisting RDNs (for all types of sedation) do not have a certificate. (Probably higher in IS-only practices).  There are currently nowhere near enough course places available if they all tried to sign up tomorrow. New accredited providers for the certificate course are likely to appear.
3. All, (including RDNs,) MUST now train to ILS+ P( Paediatric) ILS standards rather than BLS as per 2011 and repeat annually. NO date was given for this to have been completed by but ASAP I would suggest, including myself. What has changed in patient safety concerns to require this?
4. There is NO requirement to do that via Resus. Council approved courses (according to David Craig) which would otherwise mean 1 day on each of 2 separate courses. He said others can provide ILS with Paediatric add-on on the same day. I need to find out who the providers are. I will be asked. If you know, I would be grateful for that information. A one-day ILS+PILS course.
5. Some extra paperwork is now required: "Reflective Audit" and a log of every case - no longer audit depending on how much is done. Justification for each sedation on every occasion. I would suggest considering completing an IOSN form for each case to evidence this justification BUT this is not in itself a requirement.  Hint: Don't allow Pt to see score scale in part1 ( = MDAS).
6. DSTG may be creating templates for reflective Audit and a logbook of cases. This is likely to be an "upgraded" version of the old one provided via SAAD for example.  In the meantime David Craig says continue to use a version based on the SAAD log sheet. I have no idea when any replacements for these they may be made available yet.

Re Independent Trainers and mentors.

It is open to me to continue in the following way. As before the course will be facilitated with my wife, Chris Charon RDN (CDSN)

1. I can continue to provide updates for existing users without accreditation. Since ALL need their 12 hours every 5 years. I have started these with 1/2 day near Oxford on 30th May and will be running one in Glasgow probably in August/September. 
2. My reflection on the feedback are that such updates should be a whole day.
3. I can apply to have my courses accredited. I have written to Prof Ibbetson, IASCD chair, to request an application last week. He said once the forms were ready he'd arrange for one to be sent.
4. An Accreditation sub-committee is being/has now been set up.  David Craig assures me that they are not looking to make life difficult or onerous. I know what is required. I am more optimistic now but of course cannot be sure until I have been through the process. As it happens I have not yet booked a further course anyway and was not planning one until September at the earliest. That will have to be suspended until I know the outcome.
5.  I will need to ensure the course content is standardised according to the curricula now published. I believe I will not be a million miles out. I may have to re-jig the way I deliver the learning though. e.g.
6. a) A taster session to all-comers (2 hour seminars) to raise awareness and enthuse but not to teach technique or theory to any extent. I feel I will have to take time to spell out in detail all of the requirements/commitments including the total cost of provision - capital outlay + servicing + training course + mentoring days + vCPD + gases (a complex calculation which I have done!) for GDPs 

        b) The full theory and practical learning. This will be stripped of many of the elements covered in a) above.  The training day - may have to extend to 1.5 or 2 days with more detailed literature reviews, scenarios and OSCEs (Pronounced Oss-Keys for us older folk!) for example, perhaps with more problem-solving teaching techniques,  break-out discussion groups and a more in-depth summative assessment, all of which I would enjoy providing but will be more time-consuming both to prepare for and deliver. 

Mentoring 

P86 This evaluation must be made by an external assessor competent in the relevant sedation technique.

I can include GDPs + DCPs but a condition of Dental Professionals new to sedation, is that they MUST commit to the10 cases under supervision of an approved mentor, before working alone.

However If I am to mentor (once learners have completed my course or if not with me then perhaps say the SAAD weekend theory course)  then I must go back to work at the very least to undertake peripatetic cases for other practices. I am not yet clear how many per year that might be nor as I write whether than would be acceptable.

So that is about it. It does seem a shame to bin all of my experience. As you may have via social media seen I have had overwhelming support from colleagues including some who I have worked with and others who know me via reputation.

I will take this  opportunity to thank those of you who have placed their trust in me to teach and mentor them since 2003.  Remember IF I cannot get the main course accredited I will still provide updates for existing practitioners and RDNs.

regards

Richard and pp Chris Charon

As an aside , it will no longer be possible to provide Oral Sedation in the chair unless the team is trained in IV sedation.