Clinical Protocol for Specialist Domiciliary Dental Assessment

Transcription

1 Clinical Protocol for Specialist Domiciliary Dental Assessment [Clinical Protocol CP:90] [Version:1] Applies to:- Specialist Dental Services Sub Committee for Approval Clinical Effectiveness Group Date of Approval 19 th April 2016 Review Date April 2019 Title of Lead Manager Francesca Daley Policy Author Francesca Daley Summary key points:- Domiciliary assessment in non-clinical setting. Where possible make necessary adjustments to support patients to attend clinical setting for subsequent treatment. Domiciliary Assessment carried out by dentist accompanied by dental nurse. UNLESS THIS VERSION HAS BEEN TAKEN DIRECTLY FROM THE TRUST WEB SITE THERE IS NO ASSURANCE THIS IS THE CORRECT VERSION A completed Equality Impact Assessment will be available on the trusts website 1/9

2 Consultation Subject Experts Group/s Consultation NICE Lead Consulted (As required) Infection Control Approved (As required) Francesca Daley Clinical Effectiveness Group Francesca Daley Version Control Version No Type of Change Date Approved 1 New 19 th April Description of change Status New / Revised / Trust Change 2/9

3 1. INTRODUCTION Clinical Protocol for Domiciliary Dental Assessment a. A domiciliary assessment service is only provided to patients who have a physical, medical or mental health requirement which requires this assessment to take place in a non-clinical setting. The patient may be in their own home, the home of a family member or a residential/nursing home. All users are entitled to a domiciliary assessment on request if they have a genuine problem attending a dental surgery, however it is important that the patient understands that the domiciliary visit is essentially for the purposes of dental assessment and that any definitive treatment can be expected to be undertaken in the appropriate clinical setting (British Society for Disability and Oral Health Guidelines - Domiciliary Oral Healthcare Service, August, 2009). Where possible all necessary adjustments should be made to support patients to attend an appropriate clinical setting for dental assessment. 2. STATEMENT OF INTENT The Board is committed to ensuring that patients receive harm free outstanding quality care, based on best practice evidence and NICE guidelines as applicable. This document aims to ensure that appropriate standards are maintained by all clinicians carrying out assessment in the domiciliary setting. The aims of the visit are: 2.1 To assess the dental needs of the patient 2.2 To assess the most appropriate setting for the dental treatment of the patient in order to address the presenting condition. 2.3 To refer the patient to the most appropriate clinical setting. The attending dentist should, where necessary and where appropriate, offer a simple on-site treatment such as: Examination, treatment, planning and general advice Placing a dressing Simple scaling, polishing, oral hygiene and diet instruction, application of fluoride varnish Smoothing a sharp tooth Issuing a prescription Easing/repairing a denture 3. TARGET GROUP The contents of the document apply to all dentists, dental nurses and receptionists employed by the Wirral Community NHS Trust Salaried Dental Service. 4. TRAINING REQUIREMENTS All staff in the trust are required to comply with mandatory training as specified in the trusts Mandatory Training Matrix. Staff are also required to comply with job relevant training in their service as specified within their service training matrix and on the Learning and Development Section on the StaffZone 3/9

4 It is the responsibility of all dentists, nurses and receptionist to ensure they understand and are compliant with this protocol. It is the responsibility of the service manager to monitor compliance. All nurses should seek training from the domiciliary dentists or the specialist in special care dentistry. RELATED POLICIES Please refer to relevant Trust policies and procedures always use the StaffZone to ensure most recent version is accessed 5. MAIN PROCEDURE Making Appointments/Taking Referrals When taking a referral it is important to obtain as much information as possible, as it makes it easier to plan correctly for the appointment. Full Name Date of Birth Full Address with Postcode Telephone Number NHS Number Instructions regarding with whom to book appointments, if not directly with the patient, this should include any additional names, with relation to the patient, telephone numbers and requests to be present at the appointment. Also a note should be made of any times of day that are not convenient or if a fixed appointment is necessary, due to special circumstances. A brief medical history so that before arriving the dentist is aware of allergies, infectious diseases, dementia or mobility problems and the reason why the patient is unable to attend the clinic. The reason for referral for dental services. If the reason is for dental pain this should be triaged to assess if an immediate visit is required. The patient or patient s relative should be made aware of NHS dental charges and where remission from dental charges applies. Patient details should be entered onto the computer system and those waiting for routine treatment should then be placed on the waiting list with the date on which they were referred clearly marked. Patients should be made aware of the current waiting time. Before Leaving Clinic Put computer on and check diary Check messages and triage respond if necessary Check boxes are ready: materials, electrical equipment charged and returned etc. Do you have your alcohol gel? Check emergency equipment and drugs Check lab work present and decontaminated Collect patient notes NEW PATIENT CHECK-UP Lay out mirror and probe, gauze and torch Paperwork to be completed on first visit: a) Medical history- pass to Registered General Nurse (RGN) if necessary or take with patient b) Risk assessment 4/9

5 c) Moving and handling assessment d) Check exemptions/nhs charges, with staff if necessary, and record relevant details. Patient/staff to sign Practice Record (PR) form leave invoice and treatment plan if appropriate. e) Take payment if appropriate and give receipt. f) Record visit in nursing home care plan. g) Arrange follow up appointment, rebook in diary and record on patients appointment card SCALING Lay out scaler, large excavator, mirror and probe, torch and several pieces of large gauze. Hand piece with brush/cup if requested, prophylactic paste if required. Have patients own toothbrush ready. EMERGENCY DRESSING Try to arrange patient in suitable upright position, in natural light if possible with access for the dentist to work on the patient s right side. Dressing kit, torch, 2 or 3 micro brushes, cotton wool pledgets and rolls, gauze Motor, hand piece with bur, if requested Local Anaesthetic (LA) if requested, nurse to record batch number and expiry date in notes if used Filling material, spatula and mixing pad EXTRACTIONS (only if patient nursed in bed and tooth extremely mobile. Extraction checklist must be utilised) Arrange patient in suitable position with room around them, in natural light if possible. Dentist to get consent form signed Nurse to set up LA and to record batch number in notes Lay out mirror and probe, torch, forceps Haemostatic sponges and tweezers, if required Bite pack Dentist to give post-operative instructions, written and verbal, after procedure PROSTHETICS For impressions: Select and fix trays Mark set impressions with indelible pencil Alginate impressions cover with a damp tissue Take extra care to cover surfaces and patient clothing when using light body silicone as this can drip and cause staining Store bagged impressions in the dirty box for return to clinic Dentist to write lab sheet, Nurse to book new appointment and write on patient s appointment card For bite: Use kitchen or good sized work surface Take care of all work surfaces, cover well and keep heat away from things that may damage Set up and switch on iron to warm up, use silicone mat and keep iron upright Only use extension lead if necessary and then always use circuit breaker Do not set up hot air heater near fire alarm sensors 5/9

6 Cover drip tray with paper towel Switch off hot appliances when finished, to allow for cooling before replacing in box DIRTY BOX Dirty Box Contents: Nappy sacks for collecting waste. Used nappy sacks are placed in an orange clinical waste bag which is transported in a ridged plastic tool box that is securely fastened and labelled as a dirty box Dimenol disinfectant spray Tub for extracted teeth containing amalgam Indelible pencil for naming impressions 2 hard plastic tubes with screw fastening for transporting dirty instruments back to the clinic for decontamination Tall plastic tub to hold large items e.g. alginate spatula, Willis bite gauge Sharps container Orange clinical waste bag and spare Red biological substance box for lab work on its way back to the clinic for decontamination On return to clinic all laboratory work is to be disinfected according to normal policy and put ready for lab collection. Dirty instruments are to be cleaned and sterilised according to normal policy, bagged and returned to domiciliary room, for replacement in domiciliary cases RETURN TO CLINIC Used equipment to be taken to decontamination room Lab work to be taken to disinfection area, when disinfection is complete label and put into out box. Re-stock cases and re-charge electrical equipment if necessary. Dentist to complete clerical work Nurse to check and respond to telephone messages, bank any monies taken, and file patient notes CLERICAL SESSIONS Deal with messages/answer phone and faxed referrals Triage and deal with problems and questions Ring nursing homes regarding outstanding HC2 numbers and pursue outstanding debts Record details of newly referred patients onto computer and place on waiting list Arrange appointments from waiting list and record booked appointments on computer. File cards Order stock Compile and send patient contact numbers to office and bank monies Send out standard letters Deal with specialist services as required arrange blood tests, contact hospitals etc. 6/9

7 EQUIPMENT - Domiciliary Kit Examination box Mirrors Tooth Conditioner Gloves Stones Prophylactic Paste Probes Dycal Masks Cotton Pellets Corsodyl Gel Scalers Sedanol Visors Micro Brushes Brushes and Cups Tweezers Poly F Aprons Cotton Buds Duraphat Periodontal Probe Ledermix Hand Pieces, straight and contra angled Motor and rechargeable battery Vaseline Biteable Mirrors Mixing Pad Acrylic Burs Local Anaesthetic Face Mirror Dressing Kits Torch Discs Large Mixing Pad Pressure Indicating Paste Glass Ionomer Spare Batteries Mandrels Tooth Brushes Articulating Paper Alvogyl Clinell Wipes Universal Orthodontic Pliers Sharps container Wire Cutters Scissors Scalpel Extraction Box: Full Set of Extraction Forceps Haemostatic Sponges Elevators Local Anaesthetic Topical Anaesthetic Gauze Cotton Wool Rolls Tweezers Bite Packs Prosthetics Box: 2 Mixing Bowls Alginate Powder Water Measure Reline Impression Materials Medium and Light Bodied Silicones Topical Local Anaesthetic Hot Air Burner Travel Iron and Extension Cable RCD Circuit Breaking Plug Variety of Disposable Trays Edentulous, Dentate and Tray Handles Fixative Alginate Spatulas Willis Bite Gauge Wax Drip Tray and Heat Resistant Stand for Iron Wax Knives Pink Sheet Wax Soft Red Wax Sticky Wax Green Stick Ramitec for Bite Registration Shade Guide Face Mirror Torch Gloves Aprons Disposable Mirrors Tongue Depressors Denture Brushes Gauze Clinell Wipes 7/9

8 Emergency Equipment: Emergency equipment must be checked each morning before leaving the clinic. Check defibrillator is charged. Expiry dates of medication to be checked daily and expired medicines replaced O2 cylinder Face Mask and tubes Pocket Mask Guedel Air Ways (mixed sizes) Anaphylaxis Kit including Adrenaline 1:1,000 for Intra Muscular Injection Aspirin Glucogel (Dextrose Oral Gel) Salbutamol Inhaler GTN spray Midazolam 10mg/1ml Defibrillator Hand Suction Buccal Liquid Prescription Pad BNF Prescription Log Book Eyebath 6. CONSENT Valid consent must be given voluntarily by an appropriately informed person prior to any procedure or intervention. No one can give consent on behalf of another adult who is deemed to lack capacity regardless of whether the impairment is temporary or permanent. However such patients can be treated if it is deemed to be within their best interest. This must be recorded within the patient s health records with a clear rationale stated at all times. Refer to Trust Patient Information and Consent Policy for further information and guidance and the Clinical Protocol for Assessing Mental Capacity and Best Interests and Best Interests Form SHARED DECISION MAKING When developing a personalised care plan, advising on treatment options or making referrals, this need to be a joint decision with the patient and recorded in the patients health records REASONABLE ADJUSTMENTS Staff should make reasonable adjustments to enable people with Learning Disabilities (LD) or who have other protected characteristic s access to our services. A reasonable adjustment is a change that has been made to a service so that people can access care and information regarding their treatment, as anyone else. This may mean having a longer appointment time; booking a preappointment visit to the service; providing easy read information; appropriate communication or other changes that mean our services are easier to use. Patients with a learning disabilities will have an individualised Health Action Plan and will be supported to have access to annual health checks to ensure all health needs are met. WHERE TO GET ADVICE FROM Trust staff should contact their own team leader or Line Manager if further advice is needed. INCIDENT REPORTING Clinical incidents or near misses must be reported via the Trust s incident reporting system. 8/9

9 NEAR MISSES In cases where there has been a near miss, it is important to report as an incident as trends can be analysed and addressed. This system is a proactive way of preventing future incidents from actually occurring SAFEGUARDING In any situation where staff may consider the patient to be a vulnerable adult, child or young person they need to follow trust Safeguarding Policies and those of the Local Safeguarding Children s Board and discuss action plans with line manager and document outcomes. EQUALITY ASSESSMENT In line with the trusts commitment to meet its statutory requirements outlined in the Equality and Diversity Strategy each procedural document is screened using an Equality Impact Assessment (EIA) Screening Tool. This demonstrates the trusts commitment to equality and human rights by recognising that the experiences and needs of every individual are unique and strives to value and respect the diversity of staff, patients, carers and the public. EIA s support organisations to avoid discrimination on any grounds including age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion or belief, sex or sexual orientation. Carers are also protected from discrimination, as they are associated with people with a protected characteristic i.e. disabled people. Should staff become aware of any exclusions that do not comply with this statement would need to complete an incident form and an appropriate action plan put in place An equality impact assessment tool has been completed and forwarded to the Equality and Diversity Lead the EIA will be available on the trusts website. 10. References a. British Society for Disability and Oral Health. Guidelines for the delivery of a Domiciliary Oral Healthcare Service. August Associated Documents a. Clinical Protocol for Assessing the Need for Domiciliary Dental Care for Dental Services 9/9