Dental Practice POLICY:

Transcription

1 Dental Practice The purpose of this policy is to establish guidelines for the prioritizing of services offered at HealthLinc dental clinics and to give basic guidelines for the delivery of those services. Services provided at HealthLinc dental clinics will be prioritized according to the observed needs of the community and in accordance with established Federal Program guidelines. It is the policy of the dental clinics to provide as comprehensive a scope of services as possible to the populations we serve and to deliver those services in accordance with HealthLinc policy and procedures, as well as its values and mission statements. Prioritization of services and guidelines for delivery of services will take into account: Local community needs. HealthLinc capacity. Federal and Regional policies and mandates. Financial policy and fiscal concerns. Provider training and skill level. Liability issues. Availability of resources. Individual patient needs and compliance. Categorization of Services: Level I: Mandated emergency and primary preventative services. These services will be provided to all qualified patients in accordance with the policy guidelines for each individual procedure. The dental clinics will routinely have on hand all supplies and equipment necessary to complete these procedures and will provide them for the usual dental co-payment. These services will include:

2 Emergency Services: Diagnosis and treatment of acute episodic pain, infection, swelling, hemorrhage or trauma. Emergency or limited exam with appropriate radiographs. Simple extractions. Temporary or sedative restorations. Prosthetic adjustments. Pulpotomies. Endodontic access preparation and gross pulpal debridement. Incision and drainage. Prescribing of oral antibiotics and pain medication. Periodontal gross debridement Primary preventative services: Oral Health Education to include: Oral Hygiene Instructions Dietary Counseling Trauma Prevention Fluoridation Periodontal prophylaxis. Topical application of fluoride. Supplemental fluoride prescription. Oral cancer screenings. Pit and fissure sealants. Level II: Basic dental and laboratory services. These services will be provided to all qualified patients unless any exceptions or exclusions are indicated under the policy guidelines for each individual procedure. The dental clinics will routinely have on hand all supplies and equipment necessary to complete these procedures and will provide them for the usual dental copayment. For those procedures requiring a laboratory service, the patient will be required to pay a lab fee in addition to the usual dental co-payment. These services will include: Complete initial and recall examinations with appropriate radiographs. Diagnostic casts. Surgical extractions. Amalgam and composite restorations including crown build-up. Prefabricated post. Stainless steel crowns. Simple one or two canal endodontics. Complete dentures. Prosthetic repairs. Space maintainers. Athletic mouth guards. Periodontal scaling and root planing.

3 Level III: Rehabilitative and laboratory services which primarily restore oral structure. These services will be provided to all qualified patients unless any exceptions or exclusions are indicated under the policy guidelines for each individual procedure. The dental clinics may have on hand all supplies and equipment necessary to complete these procedures, but some supplies may need to be ordered on an asneeded basis. The patient will be required to pay a lab or supply fee in addition to the usual dental co-payment. These services will include: Single crowns. Fixed bridges. Cast inlays or onlays. Cast post and core. Partial dentures. Biopsy, excision of lesion Level IV: Complex rehabilitative services. These services would not routinely be provided to patients. The dentist in collaboration with the dental manager will determine the appropriateness of these services on a case-by-case basis taking into account the excess clinic time and expense needed to provide these services, as well as the skill level of the dentist. The individual needs of the patient should be balanced with the needs of the community when determining the appropriateness of providing these services. The dental clinics may have on hand all supplies and equipment necessary to complete these procedures, but some supplies may need to be ordered on an as needed basis. The patient may be required to pay an additional fee to compensate for additional clinical time, supplies or lab fees in addition to the usual dental copayment. These services may include: Molar endodontics. Surgical extractions. Apicoectomy. Periodontal surgery. Orthodontics. Complex fixed or removable prosthetic cases.

4 Dental Staff Competence Assessment Checklist The following dental staff positions will be required to have the appropriate HealthLinc Competence Assessment Checklist completed within their probationary period and reviewed yearly after that: Dental Assistant Expanded Function Dental Assistant Hygienist The Competence Assessment Checklist will be kept in the employee s credentialing file for verification purposes. The yearly Competence Assessment Checklist will be reviewed and modified if needed in conjunction with the annual performance evaluation.

5 Infection Control, Sterilization, and Disinfection Infection Control: All employees shall practice infection control techniques as prescribed by HealthLinc infection control and OSHA policy. In the dental clinic, this especially includes: Use of universal precautions by employees while in contact with any patient body fluids. This includes the use of gloves, mask, and eye protection at all times that involve possible contact with patient body fluids. Completion of appropriate immunizations as prescribed by HealthLinc policy. All material that is soaked with patient blood or saliva shall be appropriately disposed of in a biohazard container.

6 Behavior Management for Pediatric Patients in the Dental Clinic The dentist shall use only those behavior management techniques in which he/she is trained. Before the performance of certain behavior management techniques such as IV or oral conscious sedation, the dentist must have requested and been granted privileges according to HealthLinc s Policy on Credentialing and Privileging to do so. Physical restraints such as wraps, papoose boards or placing the hand over the mouth are not utilized in the dental clinics for any treatment that is not urgent. Physical restraints are only used to control patient behavior when treatment is for trauma or other emergent need and only with the written consent of the parent/guardian. Patients who do not respond to current HealthLinc treatment and behavior control protocols and whose behaviors pose a physical threat to self and/ or staff shall be referred to a pedodontist. Patient behaviors, response to management techniques, and referral are documented in the patient s electronic chart in Dentrix.

7 Radiation Control The following policies and procedures shall be followed with regard to the exposing of radiographs and radiation control. The purpose of these policies is to ensure that the exposure to patients and workers does not exceed regulatory limits and is as low as reasonably achievable (ALARA). Monitoring Badges: Monitoring badges shall be worn by all employees throughout the work day. Badges shall be left in the clinic at the end of the work day and not taken home or outside of the office. If an employee should lose a monitoring badge or holder, the clinic will replace the badge or holder the first time. Subsequent losses will need to be replaced by the employee. Monitoring reports shall be kept in an accessible place in the clinic and kept on the premises for at least 10 (ten) years.

8 Removable Prosthetics The degree of complexity of removable prosthetic cases to be provided will vary depending on the training and experience of the dentist. In general, the more complicated, timeconsuming prosthetic cases will not be offered as the normal scope of services so that more basic services can be provided to more patients. For procedures incurring a laboratory fee, the patient will pay that full fee before the case is sent to the laboratory. In the case of an immediate denture, pre-prosthetic extractions should not occur unless to relieve pain, until the laboratory fee is collected.