NITROUS OXIDE ADMINISTRATION - H.B. 4675 (H-2): COMMITTEE SUMMARY
sans-serif">House Bill 4675 (Substitute H-2 as passed by the House)
Sponsor: Representative Barb Vander Veen
House Committee: Health Policy
Senate Committee: Health Policy
CONTENT
The bill would amend the Public Health Code to allow a dental hygienist to administer nitrous oxide and allow a dental assistant to monitor and assist in the administration of the drug.
Dental Hygienist
Under the Code, upon delegation by and under the direct supervision of a dentist, a dental hygienist who meets certain educational requirements and has passed a State board exam may administer intraoral block and infiltration anesthesia to a patient who is at least 18 years old. The bill would eliminate the age restriction and expand the scope of practice for hygienists to include the administration of nitrous oxide analgesia. If a patient under the age of 18 were currently taking another sedative, however, the dentist personally would have to administer the nitrous oxide. Additionally, a dental hygienist could administer nitrous oxide only in situations in which the concentration of the drug was not more than 50%. (Under the Code, “direct supervision” means that a dentist designates a patient of record upon whom the procedures are to be performed and describes the procedures to be performed; examines the patient before prescribing the procedures to be performed and upon completion of the procedures; and is physically present in the office while the procedures are being performed.)
In order to administer intraoral block and infiltration anesthesia, a dental hygienist must successfully complete a course in local anesthesia administration offered by an dental or dental hygiene program accredited by the Commission on Dental Accreditation of the American Dental Association (ADA) and approved by the Department of Community Health (DCH). The course must contain a minimum of 15 hours of didactic instruction and 14 hours of clinical experience. The bill would retain this requirement for the administration of local anesthesia, and also require a hygienist to complete a similarly accredited and approved course in nitrous oxide administration containing a minimum of four hours of didactic instruction and four hours of clinical experience. The course would have to include content on nitrous oxide analgesia emergency medical techniques, the pharmacology of nitrous oxide, nitrous oxide techniques, and, if such a course were available, selection of pain control modalities.
The Code also requires a hygienist to complete successfully a State or regional board-administered written examination on local anesthesia within 18 months of completing the required coursework. The bill would extend this requirement to nitrous oxide analgesia, if such an examination were available and approved by the DCH.
Dental Assistant
Upon delegation by and under the direct supervision of a dentist, a registered dental assistant could assist and monitor the administration of nitrous oxide by the dentist or dental hygienist if the dental assistant had successfully completed an ADA-accredited and DCH-approved course in the assisting and monitoring of the administration of nitrous oxide analgesia. The course would have to contain a minimum of five hours of didactic instruction and include content in nitrous oxide analgesia medical emergencies techniques, the pharmacology of nitrous oxide, and nitrous oxide techniques. Under the bill, “assisting” would mean setting up equipment and placing the face mask. The term would not include titrating and turning on or off equipment. “Monitoring” would mean observing levels, admonishing, and reporting to the dentist or hygienist.
When an otherwise qualified registered dental assistant assisted in the administration of nitrous oxide, the nitrous oxide levels would have to be preset by the dentist or hygienist and could not be adjusted by the dental assistant except in an emergency, in which case the dental assistant could turn off the nitrous oxide and administer 100% oxygen.
Monitoring and assisting the administration of nitrous oxide analgesia would be at the discretion of each individual registered dental assistant who fulfilled the educational requirement.
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MCL 333.16611 - Legislative Analyst: Julie Koval
FISCAL IMPACT
The bill would have no fiscal impact on State or local government.
- Fiscal Analyst: Dana PattersonS0304\s4675sa
This analysis was prepared by nonpartisan Senate staff for use by the Senate in its deliberations and does not constitute an official statement of legislative intent.