Target Controlled Infusions Course: 401 Pre-Course Assessment
Please fill out the following questionnaire to help tailor the upcoming course to better suit your needs and ensure course pre-requisites are being met. You can save the form and come back to complete it later, however, meeting the pre-requisites is MANDATORY to be able to attend the course. Please read the FAQ's sheet provided for the course. On acceptance into the course a further email will be sent with pre-reading and other details.
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Best contact number
Current NZSSD Member
*
Please Select
Yes
No
Plan to join
*New Zealand Society for Sedation in Dentistry
Role in Sedation Team
*
Please Select
Operator-Sedationist (Dentist)
Operator-Sedationist (Specialist)
Sedationist only
Dental Assistant/Monitoring Assistant
Registered Nurse
Other
Name of organization where you will be practicing TCI.
*
Have you completed the SST online training course (Safe sedation training - license available through membership to the NZSSD). A valid and current SST certificate is a pre-requisite for the course. if you have done your SST online module over 2 years ago, you will need to complete a SST refresh module (available through NZSSD membership). If you are registering as a Nurse or Dental Assistant, we can still provide this license at a subsidized fee.
*
Yes
No
No, but I will complete this prior to the course
Please upload a digital copy of your SST certificate. PDF or JPG formats are acceptable.
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Have you previously attended the Advanced IV sedation course (Midazolam + Fentanyl) or an equivalent formal training course for dual/multi drug sedation regimes?
*
Yes
No
Other equivalent course. Please list.
I have a minimum of 2 staff members that are certified to monitor sedated patients (Completed the monitoring course or equivalent certified formal training). If you are an operator-sedationist, It is mandatory to bring one dental assistant/nurse who will be assisting with TCI sedation procedures to attend the course. If you are registering as an Assistant/Nurse, have you completed the monitoring the sedated patient course?
*
Yes
No
No, but I will have this completed prior to the course
Attending as sedationist only model/oveseas practitioner
Other
How many years have you been practicing IV sedation?
*
2 years or less
2-5 years
5-10 years
Over 10 years
Previous experience in sedation (Please leave column blank if not applicable or no experience in a particular regime).
*
Rows
1-50 cases
50-100 cases
100-200 cases
Over 200 cases
Midazolam Only
Midazolam + Fentanyl
Nitrous oxide
GA experience
What is the average number of cases yo would expect to see in a week?
*
Rows
0-2 cases
2-5 cases
5-10 cases
11 or more cases
Weekly caseload
Regarding your current sedation technique and outcomes...
*
Rows
Stronly disagree
Disagree
Neutral
Agree
Strongly agree
I am satisfied with the results
I would like more stability for my cases
I am satisfied with my technique, but would like to learn more
I would like more predictability for my sedations
Regarding management of an adverse event during IV sedation, I am confident...
*
Rows
Strongly disagree
Disagree
Neutral
Agree
Strongly agree
In managing adverse cardio respiratory outcomes
In airway management
My support staff is suitably trained
I have written checklists and guides for emergencies
I perform 6 monthly audits of my procedures
Please provide 5 case reports/notes from recent sedation cases. For Dental assistants, this is 2 case descriptions from THEIR perspective observing the patient. These should be in PDF or JPEG formats. Please also redact patient names and contact details so that these are anonymous (unless formally consented to be shared by the patients).
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* Your registration will not be confirmed without submission and review of cases.
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Why did you choose this course?
*
I need the sedation specific CPD
Interested in this topic
I would like to advance my sedation skills
I am training to assist my dentist/specialist carry out TCI sedation
Other
Is there anything in particular that you were hoping to achieve by attending this course? Any other queries?
Phone Number
*
-
Area Code
Phone Number
Please verify that you are human
*
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