6: Patient Care and Special Groups

CHAPTER 6 Patient Care and Special Groups

Criminal records bureau

The law tries to protect patients from harm, especially serious harm. In the UK, children and vulnerable people are offered formal protection via the Criminal Records Bureau (CRB) checks.

The CRB is an executive agency of the Home Office, which vets applications for people who want to work with children and vulnerable people. People working in the UK healthcare sector also require CRB checks. The role of this agency has been enhanced by the Safeguarding Vulnerable People Act (2006) in response to the recommendations of the Bichard Inquiry.

The Foster Review on the regulation of the non-medical healthcare professions, when describing ‘good character’, referred to objective tests to measure this, such as the absence of criminal convictions and adverse decisions by regulatory bodies, and the information about likely criminal activity contained in a CRB disclosure.

CRB disclosures are either ‘standard’ or ‘enhanced’.

General issues regarding patient care in the dental surgery

According to the Institute of Healthcare Management: ‘customer care fundamentally depends very much on good management and organisation, but individual staff contacts and conducts are crucial to success.’

Dress Codes

Staff are usually also expected to uphold a dress code which prevents infection, maintains health and safety and keeps a ‘professional image’. This is often some type of uniform.

You must wear a name badge that is clearly visible at all times, and which must not be defaced or broken.

Under many codes (Box 6.1.1), clinical staff must tie back long hair, but not with ribbons or combs. Jewellery is limited to simple earrings and one ring, and any clothing that exposes the midriff or cleavage is banned. Nose studs should be covered with a fresh plaster each day. Some codes also cover above-the-knee skirts and high heels. Shoes that are low-heeled, soft-soled, supportive and closed are generally agreed to be best for work. Shoes with holes in the top or side may carry a risk of injury from falling scalpels and needles, or the risk of catching an infection from blood or fluids dropping through the holes.

BOX 6.1.1 Dress Codes in Practice

Dress codes can be controversial. At least one hospital banned nurses from wearing Croc shoes, suggesting they might be dangerous. But some surgeons use Crocs in the operating theatre, believing they are easier to clean. Even NHS rules can vary. In England and Wales for example, bare-below-the-elbows dress code for clinicians is recommended since it ‘helps to support effective hand-washing and may reduce the risk of patients catching infections’. Other codes have caused considerable controversy and even made newspaper headlines. See the Daily Mail archive for example, for the article ‘Don’t forget to wear socks and make sure your shoelaces match’ (31 December 2007).

The Scottish code (published on the Scottish Government website, www.scotland.gov.uk/Publications/2008/08/interimdresscode) is reproduced below:

Whatever is the prescribed code in your workplace, as a healthcare worker, your clothing should clearly conform to health and safety standards. In some organisations, breaching the code could lead to disciplinary action.

Cleanliness and Hygiene

The dental appointment

Hazards of Healthcare

Dentistry is essentially very safe in healthy patients. Thus morbidity and mortality following dental procedures are even less excusable than when they follow, for example, more invasive surgery.

Drugs, particularly those that act on the central nervous system (CNS; e.g. sedatives and anaesthetic agents) are potentially dangerous and must be carefully administered. Most dental procedures can be carried out under local anaesthesia (LA, sometimes called local analgesia) with minimal morbidity. Conscious sedation (CS) is not as safe as LA alone. CS must be carried out:

General anaesthesia (GA) with intravenous or inhalational agents is only permitted in a hospital with appropriate resuscitation facilities. It is not often needed for dental treatment, and then only in a hospital setting: because of its potential dangers it must be carried out by a qualified anaesthetist. CS is considerably safer, and is thus preferred.

Surgical procedures are generally the most hazardous. In the dental environment, operative procedures that involve use of LA and CS, and operative interventions such as drilling teeth and cutting tissues and bone are the main ones that can be hazardous.

Risks mainly happen when staff are overambitious in terms of their skill or knowledge, the patient is not healthy, inadequate time is taken and/or the procedure is invasive (tissues are disrupted).

Thus there is always a need for doing risk assessments and careful peri-operative care.

Patient Care during Diagnosis

Risk assessment

An adequate risk assessment endeavours to anticipate and to prevent trouble. This topic was covered in the context of a medical emergency in Chapter 2. This chapter explains its relevance in day-to-day practice.

At the start of a patient’s visit it is essential to:

A patient’s ‘fitness’ for a procedure depends on several factors (see Chapter 2, Box 2.1 and Table 2.1). Many patients with life-threatening diseases now survive as a result of advances in surgical and medical care. Such diseases can significantly affect the dental management of the patient. A patient attending for dental treatment and apparently ‘fit’ may actually have a serious systemic disease. Or they may be taking drugs (including recreational drugs). Both of these might influence the healthcare that can be delivered to the patient.

The risk is greatest when surgery is needed, and when GA or sedation is given. In addition, problems may be compounded if medical support is not at hand.

History Taking

Jan 8, 2015 | Posted by in Dental Nursing and Assisting | Comments Off on 6: Patient Care and Special Groups
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