SECTION 310:667-59-15. Classification of emergency dental services

(a)   Level III. A Level III facility shall provide basic emergency dental services with at least a licensed independent practitioner, registered nurse, licensed practical nurse, or intermediate or paramedic level emergency medical technician on site twenty-four (24) hours a day. A hospital shall be classified at Level III for emergency dental services if it meets the following requirements:

(1)   Clinical services and resources. No diagnostic, surgical, or medical specialty services are required.

(2)   Personnel. A physician, licensed independent practitioner, registered nurse, licensed practical nurse, or intermediate or paramedic level emergency medical technician shall be on site twenty-four (24) hours a day.

(A)   If the facility is licensed as a General-Medical Surgical Hospital it shall also meet the personnel and staffing requirements at OAC 310:667-29-1 and any other applicable parts of this Chapter.

(B)   If the facility provides emergency medical services and is licensed as a Specialized Hospital: Psychiatric, it shall also meet the personnel and staffing requirements at OAC 310:667-33-2 and any other applicable parts of this Chapter.

(C)   If the facility provides emergency medical services and is licensed as a Specialized Hospital: Rehabilitation, it shall also meet the personnel and staffing requirements at OAC 310:667-35-3 and any other applicable parts of this Chapter.

(D)   If the facility provides emergency medical services and is licensed as a Critical Access Hospital, it shall also meet the personnel and staffing requirements at OAC 310:667-39-14 and any other applicable parts of this Chapter.

(3)   Supplies and equipment. The hospital shall have drugs necessary for the treatment of dental emergencies such as analgesics and antibiotics on site and immediately available:

(4)   Agreements and policies on transfers.

(A)   The hospital shall have written policies defining the medical conditions and circumstances for those emergency patients which may be retained for treatment in-house, and for those who require stabilizing treatment and transfer to another facility.

(B)   The facility shall have a written agreement with a dentist or oral and maxillofacial surgeon to provide immediate consultative services for dental patients twenty-four (24) hours a day. Such services shall include providing instructions for the initiation of appropriate therapy and/or patient referral to an alternate facility or immediate transfer to a facility capable of providing definitive dental care when appropriate.

(b)   Level II. A Level II facility shall provide emergency dental services with an organized emergency department. A physician and nursing staff shall be on site twenty-four (24) hours a day. The hospital shall have basic facilities for the management of minor dental emergencies. A hospital shall be classified at Level II for emergency dental services if it meets the following requirements:

(1)   Clinical services and resources.

(A)   Emergency services. A physician deemed competent in the care of the seriously ill or injured patient and credentialed by the hospital to provide emergency medical services and nursing personnel shall be on site twenty-four (24) hours a day.

(i)   For a hospital licensed as a general medical surgical hospital or specialty hospital, emergency services shall also comply with the requirements of OAC 310:667-29-1 through OAC 310:667-29-2.

(ii)   For a hospital licensed as a critical access hospital, emergency services shall also comply with OAC 310:667-39-14.

(B)   Dental services. An appropriately credentialed dental practitioner shall be on call twenty-four (24) hours a day and promptly available in the emergency department.

(C)   Oral and maxillofacial surgery. An appropriately credentialed oral and maxillofacial surgeon shall be on call twenty-four (24) hours a day and promptly available in the emergency department. For a hospital licensed as a general medical surgical hospital, surgical services shall also comply with the requirements of OAC 310:667-25-1 through OAC 310:667-25-2.

(D)   Operatory. An operatory or operating room equipped to provide treatment for dental emergencies such as odontalgia, oral hemorrhage, dental abscesses, and subluxated, avulsed, and fractured teeth shall be available twenty-four (24) hours a day.

(E)   Diagnostic imaging. The hospital shall have diagnostic x-ray services including intraoral radiography capability available twenty-four (24) hours a day. A radiology technologist shall be on duty or on call and immediately available twenty-four (24) hours a day.

(i)   For a hospital licensed as a general medical surgical hospital or specialty hospital, diagnostic imaging services shall also comply with the applicable requirements in Subchapter 23 of this Chapter.

(ii)   For a hospital licensed as critical access hospital, diagnostic imaging services shall also comply with the applicable requirements in Subchapter 39 of this Chapter.

(F)   Clinical laboratory service. The hospital shall have clinical laboratory services available twenty-four (24) hours a day. All or part of these services may be provided by arrangements with certified reference laboratories provided these services are available on an emergency basis twenty-four (24) hours a day. At least the following shall be available:

(i)   Standard analysis of blood, urine, and other body fluids to include routine chemistry and hematology testing;

(ii)   Coagulation studies;

(iii)   Comprehensive microbiology services or at least appropriate supplies for the collection, preservation, and transport of clinical specimens for aerobic and anaerobic bacterial, mycobacterial, and fungus cultures.

(iv)   For a hospital licensed as general medical surgical hospital or specialty hospital, clinical laboratory services shall also comply with the applicable requirements in Subchapter 23 of this Chapter.

(v)   For a hospital licensed as a critical access hospital, clinical laboratory services shall also comply with the applicable requirements in Subchapter 39 of this Chapter.

(2)   Personnel.

(A)   Dental practitioner. An appropriately credentialed dental practitioner shall be available for consultation on site or on call and promptly available in the emergency room twenty-four (24) hours a day.

(B)   Dental assistant. A dental assistant or other appropriately trained staff shall be on site or on call and promptly available to assist the dental practitioner in the operatory or operating room.

(3)   Supplies and equipment. In addition to the requirements at OAC 310:667-59-9(a)(3), the hospital shall have the following equipment and supplies on site, functional, and immediately available: Operatory. The operatory or operating room shall have stationary or portable equipment for use in the management of minor dental emergencies on site, functional, and available including at least the following:

(A)   Contour treatment chair or operating table appropriate for use in dental procedures;

(B)   Dental operative light;

(C)   Dental delivery unit with:

(i)   High and low-speed handpieces;

(ii)   Three way air/water syringe;

(iii)   High volume suction; and

(iv)   Saliva ejector.

(D)   Amalgamator;

(E)   Spot welder;

(F)   Rubber dams, punch, and clamps;

(G)   Sterile procedure sets for:

(i)   Tooth avulsions;

(ii)   Minor alveolar fractures;

(iii)   Endodontic kit; and

(iv)   Soft tissue tray for lacerations.

(H)   Appropriate dental tools such as mirrors, explorers, probes, curettes, excavators, burs and stones, rongeurs, elevators, files, reamers, mallet and chisels, mouth props, and amalgam tools as appropriate;

(I)   Rotary drill; and

(J)   Drugs and consumable supplies necessary for the treatment of dental emergencies such as analgesics, antibiotics, adhesives and cements.

(4)   Policies on transfers. The hospital shall have written policies defining the medical conditions and circumstances for those emergency patients which may be retained for treatment in-house, and for those who require stabilizing treatment and transfer to another facility.

(c)   Level I. A Level I facility shall provide comprehensive emergency dental services with an organized dental service and emergency department. A physician and nursing staff shall be on site twenty-four (24) hours a day. An oral and maxillofacial surgeon and anesthesiology services shall be available either on duty or on call. The hospital shall be able to provide definitive care for complex dental emergencies. A hospital shall be classified at Level I for emergency dental services if it meets the following requirements:

(1)   Clinical services and resources.

(A)   Emergency services. A physician deemed competent in the care of the seriously ill or injured patient and credentialed by the hospital to provide emergency medical services and nursing personnel shall be on site twenty-four (24) hours a day.

(i)   For a hospital licensed as a general medical surgical hospital or specialty hospital, emergency services shall also comply with the requirements of OAC 310:667-29-1 through OAC 310:667-29-2.

(ii)   For a hospital licensed as a critical access hospitals, emergency services shall also comply with OAC 310:667-39-14.

(B)   Dental services. A dental service shall be established by the medical staff. Privileges for physicians and dental practitioners participating in the dental service shall be determined by the medical staff credentialing process. The dental service shall be consulted on all patients with oral-facial pain, infection, swelling, and/or trauma.

(C)   Oral and maxillofacial surgery. A board certified or board prepared oral and maxillofacial surgeon shall be on call twenty-four (24) hours a day and promptly available in the emergency department. For a hospital licensed as a general medical surgical hospital, surgical services shall also comply with the requirements of OAC 310:667-25-1 through OAC 310:667-25-2.

(D)   Anesthesia. Anesthesia services shall be on call twenty-four (24) hours a day, promptly available, and administered as required in OAC 310:667-25-2.

(E)   Other specialties. The hospital shall also have services from the following specialties available as needed either on site or as part of a dental referral network:

(i)   Endodontics;

(ii)   Orthodontics;

(iii)   Pedodontics;

(iv)   Periodontics; and

(v)   Prosthodontics.

(F)   Operatory. A operatory equipped to provide treatment for dental emergencies such as odontalgia, oral hemorrhage, dental abscesses, and subluxated, avulsed, and fractured teeth shall be available twenty-four (24) hours a day.

(G)   Operating suite. An operating suite with thermal control equipment for patients and infusion of blood and fluids shall be available twenty-four (24) hours a day.

(H)   Post-anesthesia recovery unit. The hospital shall have a post-anesthesia recovery room or surgical intensive care unit in compliance with OAC 310:667-15-7 with nursing personnel and anesthesia services remaining in the unit until the patient is discharged from post-anesthesia care.

(I)   Intensive care unit. The hospital shall have an intensive care unit in compliance with OAC 310:667-15-7 with a registered nurse on duty in the intensive care unit whenever the unit has a patient(s). A registered nurse shall be on call and immediately available when no patients are in the unit.

(J)   Diagnostic imaging. The hospital shall have diagnostic x-ray services including intraoral radiography capability available twenty-four (24) hours a day. A radiology technologist shall be on duty or on call and immediately available twenty-four (24) hours a day. In addition to intraoral radiography, the diagnostic imaging service shall provide at least the following services:

(i)   Panoramic radiography; and

(ii)   Cephalometric radiography.

(iii)   For a hospital licensed as a general medical surgical hospital or specialty hospital, diagnostic imaging services shall also comply with the applicable requirements in Subchapter 23 of this Chapter.

(iv)   For a hospital licensed as a critical access hospital, diagnostic imaging services shall also comply with the applicable requirements in Subchapter 39 of this Chapter.

(K)   Clinical laboratory service. The hospital shall have clinical laboratory services available twenty-four (24) hours a day. All or part of these services may be provided by arrangements with certified reference laboratories provided these services are available on an emergency basis twenty-four (24) hours a day. At least the following shall be available:

(i)   Comprehensive immunohematology services including blood typing and compatibility testing. A supply of blood and blood products shall be on hand and adequate to meet expected patient needs. All blood and blood products shall be properly stored. The hospital shall have access to services provided by a community central blood bank;

(ii)   Standard analysis of blood, urine, and other body fluids to include routine chemistry and hematology testing;

(iii)   Coagulation studies;

(iv)   Blood gas/pH analysis; and

(v)   Comprehensive microbiology services or at least appropriate supplies for the collection, preservation, and transport of clinical specimens for aerobic and anaerobic bacterial, mycobacterial, and fungus cultures.

(vi)   For a hospital licensed as a general medical surgical hospital or specialty hospital, clinical laboratory services shall also comply with the applicable requirements in Subchapter 23 of this Chapter.

(vii)   For a hospital licensed as a critical access hospital, clinical laboratory services shall also comply with the applicable requirements in Subchapter 39 of this Chapter.

(2)   Personnel.

(A)   Dental practitioner. Practitioners board certified or board prepared in endodontics, orthodontics, periodontics, and prosthodontics shall be available for consultation on site or immediately available by telephone or other electronic means twenty-four (24) hours a day.

(B)   Dental assistant. A dental assistant or other appropriately trained staff shall be available to assist the dental practitioner in the operatory twenty-four hours a day.

(3)   Supplies and equipment. In addition to the requirements at OAC 310:667-59-9(a)(3), the hospital shall have the following equipment and supplies on site, functional, and immediately available: Operatory. The operatory shall have stationary or portable equipment for use in the management of minor dental emergencies on site, functional, and available including at least the following:

(A)   Contour treatment chair;

(B)   Dental operative light;

(C)   Dental delivery unit with:

(i)   High and low-speed handpieces;

(ii)   Three way air/water syringe;

(iii)   High volume suction; and

(iv)   Saliva ejector.

(D)   Amalgamator;

(E)   Spot welder;

(F)   Rubber dams, punch, and clamps;

(G)   Sterile procedure sets for:

(i)   Tooth avulsions;

(ii)   Minor alveolar fractures;

(iii)   Endodontic kit; and

(iv)   Soft tissue tray for lacerations.

(H)   Appropriate dental tools such as mirrors, explorers, probes, curettes, excavators, burs and stones, rongeurs, elevators, files, reamers, mallet and chisels, mouth props, and amalgam tools as appropriate;

(I)   Rotary drill; and

(J)   Drugs and consumable supplies necessary for the treatment of dental emergencies such as analgesics, antibiotics, adhesives and cements.

(4)   Policies on transfers. The hospital shall have written policies defining the medical conditions and circumstances for those emergency patients which may be retained for treatment in-house, and for those who require stabilizing treatment and transfer to another facility.

[Source: Added at 17 Ok Reg 2992, eff 7-13-00; Amended at 20 Ok Reg 1664, eff 6-12-03]