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Standards for Conscious Sedation FAQ

Why were the new IACSD standards necessary?

The new standards respond to changes in sedation practice and in the requirements for education, training and its validation. There was also an appreciation that common standards needed to be applied to the use of conscious sedation by everyone in the healthcare team - dentists, doctors, nurses and other DCPs. The new standards were agreed by a wide range of organisations including the Dental Faculties of the surgical Royal Colleges, the Royal College of Anaesthetists and  specialist societies.

When do the new standards become effective?

From the date of publication of the report on 22 April 2015.

I am an experienced provider of conscious sedation. Do I need to re-train or undertake a postgraduate certificate or diploma in conscious sedation?

Experienced sedation practitioners are covered by the Transitional Arrangements but you must comply with the standards in all other sections of the report. A postgraduate sedation qualification is not mandatory.

Must all sedation courses now be accredited?

All courses intended for practitioners who wish to undertake training in a sedation technique that leads to independent clinical practice must now include supervised clinical training and have external validation. UK university-based courses and those run by Postgraduate Deaneries are compliant. Other courses which lead to independent practice, including those run by private providers, must be accredited by IACSD/STAC (Sedation Training Accreditation Committee). CPD and ‘update’ courses offering only knowledge and skills training do not need external accreditation.

How do I apply for course accreditation?

You should contact Neil Sutcliffe at FDS RCS Eng (stac@rcseng.ac.uk) for information about the accreditation process, including when the first applications will be accepted.

I enrolled on a training course prior to April 22 2015 and I am currently completing my mentored cases. Will I be compliant with the new guidelines?

Yes, you are compliant with the spirit of the IACSD standards. When you have completed your training you will then be covered by the Transitional Arrangements.

I have been on the DSTG list of mentors for many years and have successfully mentored a number of dentists learning to use conscious sedation. Must I now stop doing this?

The STAC (Sedation Training Accreditation Committee) is able to accredit "sedation supervisors" (see above).

Does sedation carried out as part of DCT2 training satisfy the requirements for conscious sedation training?

Training provided by a Deanery or a University does not need to be accredited, but to reach the level of independent practice, the training provided should follow the standards as set out in the IACSD Report.  All sedation experience will be useful and should be recorded in your clinical logbook.

May new DF3’s provide IV and inhalational sedation under appropriate supervision?

Yes, they may. However this will not allow them to undertake independent clinical practice using these techniques once DF3 is completed, unless the DF3 training programme meets the requirements set out in the IACSD standards.

I have over 25 years of experience using IVS but now carry out less than one case per month. Should I continue?

This is a matter for you to decide, perhaps in consultation with your professional indemnity organisation.  As an experienced practitioner you are covered by the Transitional Arrangements but carrying out only one case per month may not be considered sufficient for maintaining competence.  You should also consider the IACSD CPD requirements.

I am intending to employ a GMP colleague to provide sedation in my practice – must he undertake training in dental sedation?

Yes, the new guidance applies to doctors and dentists. Your colleague must acquire knowledge, skills and supervised clinical experience before providing sedation in your practice. Training opportunities are currently more limited for doctors than dentists.

What training does the ‘second appropriate person’ now require?

Dental Nurses must be trained and experienced but, like dentists, are covered by the Transitional Arrangements. The NEBDN Certificate in Conscious Sedation Nursing is highly recommended but not mandatory.

Is it possible to gain a qualification in dental nursing for IS alone?

We understand that NEBDN is considering offering this but do not know the timescale. You should contact either NEBDN or your local Dental Deanery for availability of courses.

When will registered Dental Nurses be obliged to have the NEBDN Certificate in Dental Sedation Nursing?

There are no plans to make this qualification compulsory. However, all Dental Nurses should be encouraged to work towards it.

I have two dental nurses. Does the chairside nurse need to be sedation-trained?

No, as long the sedation-trained nurse is appropriately trained and experienced and remains in the surgery throughout the procedure. However, it might offer greater flexibility if both nurses were sedation-trained.

What level of life support training does the sedation team need?

Practitioners must be able to provide age-appropriate immediate life support as defined by the main elements of the Resuscitation Council (UK) ILS and PILS training programmes. It is not essential to undertake a Resuscitation Council (UK) accredited ILS/PILS course. Alternative courses with equivalent content which are adapted to the needs of dental practice are acceptable: these might also include the management of common sedation, medical and dental emergencies.

Can I continue to provide IS whilst waiting to attend an immediate life support course?

All dentists should have current immediate life support skills. You should contact your professional indemnity organisation for advice.

How can I demonstrate that my practice facilities are equivalent to those of an ‘NHS Acute Trust in England’ (Options for Care, page 9)?

You must be able to provide evidence that in the event of a patient collapse you have the knowledge, skills and facilities to offer the same quality of immediate care as would be expected in an NHS Acute Trust. Evidence might include written protocols for managing collapse and adverse reactions, the timely transfer of a collapsed patient to a hospital with appropriate resuscitation facilities and the regular checking of emergency drugs and equipment. Current immediate life support (see FAQ 16) certificates and records of regular team-based participation in real-time emergency scenarios would also be appropriate. The SAAD Safe Sedation Practice Scheme (www.saad.org.uk) covers some of these elements. The checklist used by SAAD inspectors is available for download and may be used for self-assessment. It is not the responsibility of IACSD to assess evidence.

How can I find out more about the SAAD Safe Sedation Practice Scheme?

You should contact the Executive Secretary at SAAD at www.saad.org.uk.

How can I show that I have ‘skills equivalent to those expected of a specialist/consultant in paediatric dentistry’ or ‘a consultant in anaesthesia competent in sedation for dentistry’ (Options for Care, page 8)?

You must be able to provide evidence that the person leading the team possesses the knowledge and skills which will ensure that treatment planning and care under conscious sedation will be delivered to the same standard as would be expected of a specialist. Evidence might include training (including CPD, postgraduate qualifications, clinical attachments, honorary NHS appointments etc.) and documented experience appropriate to the age group/s to be treated. A good record of experience would include dated (but anonymised) patient data including age, ASA status, sedation technique, monitoring, dental treatment, recovery, outcome, adverse incidents and a summary of the number of sedation cases managed per year. The training and experience of other members of the sedation team, any support available from a local peer, consultant or MCN and the equipment and facilities available might also be relevant. The SAAD Safe Sedation Practice Scheme covers some of these elements. The checklist used by SAAD inspectors is available for download and may be used for self-assessment. Written support from specialist/consultant who is familiar with your experience might also be helpful. The syllabuses in Appendix 1 define the knowledge and skills required of the whole team for a variety of techniques and age groups.

How can I show that I have ‘skills equivalent to those expected of a consultant in anaesthesia competent in sedation for dentistry’’ (Options for Care, page 8)?

If you are an anaesthetist (i.e. on the GMC Specialist Register in anaesthetics) wishing to commence providing dental conscious sedation for children and young people you must be able to demonstrate training and experience in paediatric anaesthesia to a standard equivalent to that detailed in the paediatric section of the RCoA curriculum and acquisition of the competencies outlined in the RCoA dental sedation curriculum (IACSD Ref 34).

If you are an anaesthetist already engaged in the provision of dental conscious sedation for children and young people you must be able to demonstrate that you possess the necessary competencies for safe independent sedation practice. Formal appraisal/revalidation for this activity would include demonstration of appropriate paediatric anaesthetic training and experience, possession of the necessary paediatric dental sedation competencies (IACSD Ref 34), ongoing experience (logbook of sedation activity), evidence of appropriate continuing professional development, participation in audit of practice and outcomes and documentation of any complaints

If you are a medical or dental practitioner you must be able to provide evidence that you possess the knowledge and skills which will ensure that conscious sedation will be delivered to the same standard as would be expected of a specialist in anaesthesia (see above) who is competent in sedation for dentistry. This includes competence in age-appropriate ‘rescue’ procedures in the event of cardio-respiratory complications associated with a deeper level of sedation than intended. However, you are not expected to possess broader anaesthetic skills which are not directly relevant to the administration of dental conscious sedation or its complications. Evidence might include formal appraisal/revalidation, training (including CPD, postgraduate qualifications, clinical attachments, honorary NHS appointments etc.) and documented experience appropriate to the age group/s to be treated. A satisfactory record of experience would include dated (but anonymised) patient data including age, ASA status, sedation technique, monitoring, dental treatment, recovery, outcome, adverse incidents and a summary of the number of sedation cases managed per year. The training and experience of other members of the sedation team, support available from a local peer, specialist anaesthetist or MCN and the equipment and facilities available might also be relevant. The SAAD Safe Sedation Practice Scheme covers some of these elements. The checklist used by SAAD inspectors is available for download and may be used for self-assessment. Written support from a specialist anaesthetist who is familiar with your experience might also be helpful. The syllabuses in Appendix 1 define the knowledge and skills required of the whole team for a variety of techniques and age groups

I have been asked to provide IVS at another dental practice. I have many years of experience but no formal qualification in sedation. Is this permitted?

Yes, you are covered by the ‘Transitional Arrangements’ but you must comply with all other sections of the IACSD document.

May a Dental Therapist or Hygienist provide inhalational sedation without a dentist being on the premises?

Yes, as long as the Dental Therapist or Hygienist is supported by an appropriately trained and experienced Dental Nurse (‘second appropriate person’).

When should I take an adult patient’s blood pressure during IVS?

NIBP should be performed before and after sedation and at ‘appropriate intervals’ during the procedure. The intervals are determined following individual patient assessment.

Should I consider buying a capnograph for my IVS service?

Capnography is not currently recommended for routine use in fit dental patients.  However, it detects hypoventilation sooner than pulse oximetry and so it is likely to become more widely used, especially for medically compromised patients.

May I use the IACSD information leaflets in my practice?

Yes, you may use them unchanged as long as you acknowledge the Dental Faculties of the surgical Royal Colleges and the Royal College of Anaesthetists. The information leaflets are for guidance in good practice and if you wish to amend the leaflets for your local requirements, then they must not display the logo of any of the Royal Colleges.

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