Managing yourselves, your teams and your patients in unprecedented times
Exploring some of the main queries the dental advisory team at MDDUS has received during the COVID-19 outbreak
I feel I can speak for our entire dental profession when I say the challenges of COVID-19 have been wide-reaching and have had an extensive impact on our ability to practice as normal, requiring us all to make significant changes to adapt to this new operating environment.
It’s been a difficult and challenging period for which we have had little time to prepare, and we may now find ourselves working in clinical scenarios far removed from our day-to-day professional practice.
Although we appear to be reaching the point where lockdown will begin to be eased, there is certainly little likelihood of a rapid return to normal. Indeed, it’s questionable whether what we once knew as normal will ever apply again.
Therefore, in this article I’ve explored some of the main queries our dental advisory team at MDDUS has received during the COVID-19 outbreak, with the aim of assisting you in managing yourselves, your team and your patients in these unprecedented times.
It is vitally important in these challenging times that all dental practitioners are fully cognisant of all guidance from the Chief Dental Officer in their relative jurisdiction or home nation and implement this appropriately, reflective of their type of practice. It is also advisable to consult the most up-to-date advice from the Faculty of General Dental Practice in terms of emergency patients, the British Dental Association for risk assessment and any other advice from your Local Dental Committee. Of course, the Scottish Dental Clinical Effectiveness Programme remains, very much, the authoritative advice in terms of managing emergency patients and, in particular, antibiotic prescribing in our current circumstances.
In terms of indemnity provision, MDDUS members are on the equivalent of one session unless it has been requested that we amend this for them. We recognise the challenging circumstances under which our members are operating, and we have written to them to advise that we will retrospectively be able to look back and amend cover, in terms of how our dental members’ workplaces may have changed regarding indemnity, even if it has not been possible for them to get in contact with us to advise us of this over the course of the pandemic.
Please check your own indemnity cover with your Medical Defence Organisation.
With regard to triaging patients, it is critical that dental professionals work within their scope of competence at all times.
Orthodontic therapists should not be triaging patients as it is not within their scope of practice to diagnose disease, but this does not mean that they cannot speak to the patient or a parent regarding an orthodontic emergency. An orthodontic therapist could obtain the information from the patient or parent, but they must get an orthodontist or dentist to review that information and provide the diagnosis and the prescription for what should be done regarding the emergency.
Dental hygienists and therapists will be able to triage patients and diagnose, but it is critical that there is a dentist available with whom you can discuss any concerns. The prescribing of antibiotics will have to be carried out by a dentist.
Remote consulting and prescribing
In recent times and in response to the challenging circumstances dental practitioners are operating in, MDDUS has seen excellent examples of telephone triaging, and triaging carried out using video facilities such as FaceTime. If you do have the means to record these conferences it would be helpful for the patient’s record for it to be uploaded as supporting information. In addition, you will need to create an accurate, complete and contemporaneous record of the consultation. It would also be worthwhile to make a note of the challenging times we are working under in the patient’s record.
Remote prescribing can present a challenge when patient records are unavailable remotely and you have no patient background. If carrying out remote prescribing, your questions to the patient must be very clear and follow the template you would use in surgery. Especially important are medical history questions and those looking at any current prescribed medication the patient is taking.
Consent refers to the voluntary continued permission from a patient to receive a particular treatment based on a comprehensive knowledge of the purpose, nature and likely risks of the treatment, including the probability of success and any alternative treatment, without being subject to any unwanted or unjust pressure.
It is critical that patients understand the limitations of the care that can be provided in these unprecedented times, including any options for treatment, to help inform their decision as to how they want to move forward with the treatment that is on offer to them. This is especially important at present where patients may come in and the only option is extraction, or if the correct PPE is not available, a course of antibiotics.
It is very important that we stay fit and well in these challenging circumstances. As an employer, you have a duty of care to your staff to ensure they are keeping well, and so it is advisable that you stay in regular contact with them. Some of the things we can do to promote our own wellbeing include taking regular exercise, staying in contact with colleagues and eating well. We can also use resources available from the Dentist Health Support Trust, the British Dental Association and Confidental to support us in these unprecedented times.