Chapter 9
Conscious Sedation 3: Preparing the Dental Team and Facilities
Aim
The aim of this chapter is to outline how the dental team and the surgery facilities need to be prepared before offering conscious sedation to a child.
Outcome
The dental practitioner should be able to
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develop the roles to be preformed by each member of the dental sedation team
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understand the appropriateness of both clinical and electronic monitoring
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handle all drugs safely, particularly nitrous oxide gas.
Introduction
Dental practitioners who wish to offer a conscious sedation service to their patients have a responsibility to ensure that they and their staff are appropriately trained to deliver best-quality care and to assist should a rare emergency arise. In Chapter 3 the individual, yet complementary, roles that each team member performs were presented. Whenever conscious sedation is offered to patients these roles are expanded further and it is even more important for the team both to be fully conversant with their own individual role and also to have the ability to transfer and integrate their skills to ensure the continued well-being of their sedated child patient. In addition to this, special consideration has to be given to the facilities and equipment in the dental practice where sedation is offered and to the continued health and safety of the dental staff.
Preparing the Dental Team
Each member of the dental team has a specific role to play in managing an anxious child and their escort when they present for the conscious sedation appointment. The key roles are:
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to prepare the dental team to manage both an anxious child and a sedated child
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to prepare the equipment.
Training
Before sedating a child, all members of the dental team must receive
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theoretical training
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practical training
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clinical training
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training in how to manage complications.
Each aspect of this training process must include the use of the specific sedative agent that has been planned for the child patient. It is also essential that the team has experience in the behavioural management of children and is competent in the operative procedures that are planned. Clinical and theoretical training in the provision of conscious sedation is not enough; the team must also be trained to recognise and to manage sedation-related complications. The ability to rescue the child is essential in the event of complications. Indeed, in a review of clinical incidents relating to sedation in children it was the inability to recognise complications and then subsequently rescue the child that lead to clinical incidents.
Every dental team already knows that there are specific guidelines in respect of training in basic life support to which they must conform, even if sedation is not being offered in the practice. Clearly, a team that offers conscious sedation to anxious children has to prepare further to ensure that that knowledge is retained and skills updated. To achieve this each member needs to be involved in a programme of continuous education and assessment relating to both operative paediatric dentistry and conscious sedation. Organisations that offer this kind of post graduate training in sedation are listed at the end of this chapter.
The receptionist
The receptionist is the face of the dental team and must be aware that the first contact can do much to alleviate or to cause anxiety as well as inspiring confidence in the success of the procedure. The role of the receptionist has been discussed already (Chapter 3) but there are some specific additional duties relating to conscious sedation that can be assumed by reception staff.
The receptionist has the pivotal role in the emergency protocol. They must be the person in charge of contacting the emergency services should this be required.
Key Roles and Duties
Dental receptionist
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Being the face of the dental team.
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Issuing pre-appointment letter.
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Ensuring pre-operative instructions are given and clearly understood.
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Logging appointment.
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Preventing crowding in the surgery.
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Confirming that the child has an appropriate escort and transport home.
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Completing anxiety questionnaires (if desired).
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Having a specific assignment in the event of an emergency.
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Updating knowledge of the emergency trolley inventory.
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Knowing basic life support.
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Implementing the emergency services protocol and facilitating patient transfer (if necessary).
Dental nurse
The dental nurse is a key member of the dental team in the management of the anxious child. Calm support and participation in behavioural management techniques are essential for any treatment to succeed. Do not underestimate the role of the dental nurse as a chaperone. Sadly, nowadays, every dentist, irrespective of gender, needs to be chaperoned for their own safety, but never more so when sedative drugs are used, as many sedative drugs cause hallucinations.
THE DENTIST MUST BE CHAPERONED.
In conscious sedation for dentistry, the dental nurse often also acts as the sedation assistant by monitoring the sedated child and/or sedation equipment. Like the receptionist, he or she has specific assignments in the event of an emergency. The whole team should periodically practise these emergency scenarios. The dental nurse must have knowledge of the emergency trolley inventory and may also have the additional responsibility of ensuring that drugs are kept within their “use-by-dates”. Finally, they should, like the rest of the dental team, be able to demonstrate basic life support skills.
Key Roles and Duties
Dental nurse
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Providing calm support.
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Participating in behavioural management procedures.
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Chaperoning clinician.
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Practising patient rapport.
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Monitoring.
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Knowing basic life support.
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Initiating patient rescue.
The dental nurse must:
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monitor the patient during sedation
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have a specific assignment in the event of an emergency
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have current knowledge of the emergency trolley inventory
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be able to demonstrate basic life support skills.
The Family Dentist as a Sedationist
A dentist must only use conscious sedation for which he or she has been specifically trained and found competent.
It is important that conscious sedation is used as an extension of behavioural management techniques. With that in mind it is assumed that the dental sedationist will use techniques appropriate to the individual child, as described in previous chapters. In addition, there are specific supplementary roles and responsibilities relating to conscious sedation.
Key Roles and Duties
Dental sedationist
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Assessing the dental and medical health of the child.
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Gaining informed consent.
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Prescribing and administering sedation.
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Monitoring sedated child.
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Post-procedurally caring for and discharging child.
The dental sedationist must:
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understand the pharmac/>
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