Dental Care in Domiciliary Setting Protocol - NHS Bradford and ...

Protocol for Dental Care in a Domiciliary Setting
Responsible head of service: Swarngit Shahid, Clinical Director
Name of responsible committee: Professional Advisory Sub-Committee
Name of Author
If you are using a printed copy of this document please be aware that it may not be the
latest version. To view the latest version visit
http://nww.bradford.nhs.uk/extranet/Policies/Pages/default.aspx
Salaried Dental Service Quality and
Governance Group
Contact for further details: Mrs S Shahid – Clinical Director
Version: 2
Supersedes: Domiciliary protocol
Date Approved:
Review due:
Key Words:
17 th September 2010
by 17 th September 2013
Dental
Domiciliary
Document type: Protocol
NOTE 1:
Clinical guidelines are designed to assist practitioner and patient decisions about appropriate
health care for specific clinical circumstances and to support rather than replace clinical judgment
and patient choice. In some situations it is right for the practitioner to deviate from the clinical
guideline where this is in the best interests of the patient. Where there is doubt advice must be
sought. In these cases it is essential that clear records are maintained of the steps taken and
supporting rationale.
NOTE 2:
All clinical guidelines remain valid until notification of an amended clinical guideline is placed on
the intranet.
Protocol for Dental Care in a Domiciliary Setting v2 Page 1 of 50
©BACHS 2010

Contents
Section Topic Page
1 Introduction 5
2 Aims 5
3 Scope 5
4 Dental care pathway for domiciliary patients 5
4.1 Objectives 5
4.2 Access to domiciliary care 5
4.3 Referring patients for domiciliary care 6
4.4 Processing the referral and assessing the eligibility for domiciliary care 6
4.5 Referral received at clinic 6
4.6 Preparation prior to the visit 6
4.7 The initial visit 7
4.8 Subsequent appointments 10
4.9 Completion of treatment 10
5 Special considerations when undertaking domiciliary care 10
5.1 Infection control 10
5.2 Medical emergencies in the domiciliary setting 10
5.3 Health and safety 11
6
Procedure for requests for new dentures which have been lost or
damaged by the hospital/care home
7 References 12
Protocol for Dental Care in a Domiciliary Setting v2 Page 2 of 50
©BACHS 2010
11

Appendices
Appendix Topic Page
1 Care pathway for domiciliary care 13
2 Bradford and Airedale Salaried Dental Service referral form 14
3 Eligibility assessment for domiciliary care 16
4 Decision-making process for domiciliary care 17
5 Pre-appointment questionnaire 18
6 Collecting patient charges on domiciliary visits 20
7 Domiciliary visit risk assessment form 21
8 Assessment of capacity form 23
9 Equipment lists 25
10 Risk assessment for domiciliary instruments 28
11 Manual handling risk assessment form 29
12 Oral health care plan 31
13 Lone worker security policy 32
14 Manual handling risk assessment for domiciliary resources 34
15 Emergency equipment including oxygen carriage 35
16
Procedure for requests for new dentures which have been
lost/damaged in the hospital/care home
17 Copy of FP17 R/11 form 37
18 Equality impact assessment tool 39
19 Checklist for review and approval 44
20 Document review 45
21 Plan for dissemination of documents 48
22 Dissemination record 49
23 Summary of policy development and consultation 50
Protocol for Dental Care in a Domiciliary Setting v2 Page 3 of 50
©BACHS 2010
36

Version Date Author Status Comment
2 Aug 10 B+A SDS Q+G grp For PASC
2 Sept 10 As above Approved
by PASC
Protocol for Dental Care in a Domiciliary Setting v2 Page 4 of 50
©BACHS 2010

1. Introduction
The strategic direction for driving improvements in the quality of care across the health service
is set out in the final report of the NHS Next Stage Review ‘High Quality Care for All’. High
quality oral healthcare should be available to all people regardless of their age or
circumstances. People with long term and/or progressive medical condition; mental illness or
dementia and increasing frailty are not always able to travel to a dental surgery. For some
people access to oral healthcare services is achievable only through the provision of domiciliary
oral healthcare (British Society for Disability and Oral Health 2009). Bradford and Airedale
Salaried Dental Service provide domiciliary care that reaches out to patients who cannot
access a service by themselves for reasons of disabilities. The dental care is carried out in an
environment where the patient is resident either permanently or temporarily. It will normally
include residential units and nursing homes, day centres and the patient’s own home.
2. Aims
3. Scope
• To deliver appropriate oral health care provided in a consistent manner to patients
whose circumstances make it impossible, unreasonable or otherwise impractical for
them to receive care in a fixed clinic.
• To deliver care to these patients in the safest and most effective way.
• The following document outlines the care pathway available to patients in a domiciliary
setting and the associated documentation. The aim is to ensure patients receive timely
evidence-based dental care and preventative advice
The purpose of this document is to provide guidance to staff within the Bradford and Airedale
Salaried Dental Service.
4. Dental Care Pathway for domiciliary patients
The care pathway for domiciliary care can be found in Appendix 1
4.1. Objectives
The objectives of domiciliary care are primarily to:
• Establish a system which will identify individuals in the community who have an oral
healthcare need and for whom domiciliary provision is the only reasonable option.
• Provide an oral healthcare service to address patients needs, taking into account their
personal circumstances and their wishes, consistent with the most appropriate use of
resources
• Deliver high quality oral healthcare in a person-centred way that respects the dignity of
the individual receiving it.
4.2. Access to domiciliary care
Liaison with health and social service professionals, carers and the voluntary sector will enable
clients who require a domiciliary service to access care. Older people can be referred for
domiciliary care by any member of their multidisciplinary team. Care homes should have
access to information on local dental services including advice on referrals and information on
domiciliary care.
Protocol for Dental Care in a Domiciliary Setting v2 Page 5 of 50
©BACHS 2010

4.3. Referring patients for domiciliary care
• Where possible referrals should be made on the Bradford and Airedale Salaried Dental
Service form (see Appendix 2). As this will provide the information needed to care for
the patient in an appropriate and timely manner.
• In case of emergencies verbal referrals can be accepted and the form completed later.
Urgent referrals can be difficult to fit into an already scheduled working day and both
eligibility for a visit and the degree of urgency will need to be assessed (see section 4.5
below and Appendix 3). Any verbal referrals or urgent requests must be forwarded to
the Dental Office for monitoring purposes.
4.3.1. Referrals are accepted for:
Patients who:
• Have a General Medical Practitioner (GMP) in the Bradford and Airedale district
• Would find it impractical or impossible to attend the dental surgery for dental
treatment ie for some patients with:
o Physical and learning disabilities
o Mental health problems eg Alzheimer’s disease, agoraphobia
o Medical conditions eg terminal illness, chronic obstructive airway disease.
o Patients in hospital, palliative care units and nursing homes (who are unable
to access the General Dental Service)
4.3.2. Referrals are not accepted for:
Patients who:
• are able to access the dental surgery
• are able to travel to the dental surgery with assistance
• claim benefit to allow them to access health services such as the mobility
component of Disability Living Allowance.
4.4. Processing the referral and assessing the eligibility for domiciliary care
Referrals for Domiciliary Care follow the standard process for Bradford and Airedale Salaried
Dental Service (K Drive/SDSDental/Access/Managing referrals).
Once the referral has been received at a member of the triage team will contact the patient and
assess their eligibility for domiciliary care using the eligibility questionnaire (Appendix 3). Once
this has been completed the questionnaire is reviewed by a dentist or other appropriate person,
and a decision is made whether the patient should be assessed at home, or scheduled to
attend the clinic. The flow chart ‘Decision Making Process for Domiciliary Dental Treatment’
(Appendix 4) can be used by the clinician to help make an appropriate decision. Once eligibility
has been confirmed the patient referral is forwarded to the appropriate clinic.
4.5. Referral received at the clinic
Once the referral is received at the clinic the patient details are placed on the domiciliary
waiting list. Patients deemed by the clinician to need urgent assessment (patients who have a
condition recognised as urgent or emergency using the Department of Health Guidelines)
should be seen as soon as practicable by any available dentist.
4.6. Preparation prior to the initial visit.
When the patient comes to the top of the waiting list they or in some circumstances the carer/s
are contacted by the receptionist/dental nurse to arrange an appointment. At this time a pre-
Protocol for Dental Care in a Domiciliary Setting v2 Page 6 of 50
©BACHS 2010

appointment questionnaire (Appendix 5) is completed with the patient/carer. This provides
information to ensure the dentist has sufficient information to plan the initial visit appropriately.
At this initial contact it is imperative to ascertain whether the patient is exempt from NHS dental
charges. If dental charges are to be made then the patient/carer should confirm how a payment
will be made on the first visit. It should be explained to them that full payment for treatment
received must be made prior to completion of the course of treatment i.e. fitting of dentures.
4.7. The initial visit.
The purpose of the initial visit is to assess the patient’s needs in terms of their physical needs,
ability to accept and cope with treatment and their clinical needs to achieve satisfactory oral
health. A domiciliary risk assessment is carried out at the initial visit (see below) and this
informs the subsequent risk-benefit analysis for providing domiciliary care.
4.7.1. Before leaving the clinic
• Telephone the patient at the beginning of the day to confirm the timetable.
• Confirm how (unless patient is exempt dental NHS charges) payment is going to
be made at the first visit. See Appendix 6 - Collecting patient charges on
domiciliary visits.
• For security provide the name of dentist visiting.
• Try to be punctual. If a delay is anticipated, then telephone to apologise, explain
and reassure that the appointment will still be kept; carers may have made
special arrangements to be available for a particular time.
• Ensure every member of the dental team has their official identification.
• Provide a responsible person with the details of where you are visiting and your
estimated return time, and contact numbers for you if you do not return on time.
4.7.1.1. Clinical records and administration
The following should be taken to the assessment appointment
• Clinical record card
• Medical history forms
• PR11 form
• FP17DC
• Domiciliary risk assessment form (Appendix 7)
• Assessment of capacity form (Appendix 8)
A full list of administrative items can be found in Appendix 9 ‘Domiciliary Kits’
4.7.1.2. Equipment
The exact equipment that you will need will depend on the needs of the patient and
whether you may need to conduct any emergency treatment. For domiciliary care
the equipment is organised into kits (Appendix 9). The minimum required is as
follows:
• General kit
• Emergency kit
• Administrative kit
Further information regarding the equipment kits and risk assessment can be found
in Appendix 10 ‘Risk Assessment for Domiciliary Instruments’
Protocol for Dental Care in a Domiciliary Setting v2 Page 7 of 50
©BACHS 2010

4.7.2. Assessing the patient
On arrival the dental team should introduce themselves and show the patient or their
carer their ID badges. Positively identify the patient and ascertain any carers
relationship to the patient. Following introductions the following sequence should be
carried out. Some aspects are explained more fully in subsequent sections.
• Explain to the patient/carer that before you examine them you need to undertake a
domiciliary risk assessment to ensure that it is safe for them and for you to
undertake treatment away from the surgery. (Appendix 7)
o complete the environment/safety assessment
o complete the manual handling section and if a risk is identified a formal
manual handling risk assessment will need to be carried out. For further
information please see NHS Bradford and Airedale Manual Handling
Policy which can be found at:
http://nww.bradford.nhs.uk/extranet/Policies/Published%20Policies/Manu
al%20Handling.pdf
The Manual Handling Risk Assessment form is enclosed in Appendix 11
• Confirm the patient’s exemption or if needed take payment from the patient at
Band 1 charge.
• Complete the necessary paperwork i.e. PR form
• Confirm the medical and dental history with the patient, if there are any concerns
about the patient’s ability to provide a reliable history this should be discussed with
the carer.
• Assess the patient’s capacity to consent to an examination, and consider their
capacity to consent to any treatment needed. (see section 4.7.4.1)
• Carry out a full dental examination and provide a Personal Dental Treatment Plan
with estimate of treatment charges (FP17DC) to the patient. You may wish to
outline or provide an initial treatment plan to the patient at this stage particularly if
the treatment required is complex or if the treatment the patient needs is to be a
combination of clinic and domiciliary care.
• If able carry out any necessary urgent dental care needed
4.7.3. Treating patients in the domiciliary setting
Any treatment carried out must be in the best interests of the patient, and be able to be
completed safely from a patient and clinician perspective
4.7.3.1. Treatments suitable for a domiciliary setting
The following can normally be safely carried out in a domiciliary setting:
• Examination
• Temporary dressing
• Scale and polish
• Oral hygiene advice
• Prescriptions
• Provision of dentures and related treatments
4.7.3.2. Treatments that may be unsuitable for a domiciliary setting
The following treatments may not be suitable for a domiciliary setting. The treating
dentist should ensure that if they are carrying out such treatments in a domiciliary
Protocol for Dental Care in a Domiciliary Setting v2 Page 8 of 50
©BACHS 2010

setting that a full assessment of the risks and benefits of the treatment has been
carried out, discussed with the patient/carers and documented fully in the clinical
notes.
• Administration of local anaesthetics
• Minor oral surgery
• Conservation of teeth where use of air rotas/local anaesthetic is indicated
4.7.3.3. Disputed or unusual treatment plans
In cases where there is any disagreement over proposed treatments, the principle of
‘wide consultation’ should be adopted. Where proposed treatments are disputed,
could be considered unusual, or would for special reasons fall outside that which
may be considered to be within the recognised body of professional opinion, further
advice must be sought from senior colleagues, or peers, before proceeding except
where over-riding necessity indicates otherwise.
4.7.4. Consent
It is the duty of the dentist who proposes to carry out the treatment to ensure that a valid
consent is obtained. Consent must be informed, and where a client is considered not to
have the capacity to consent, the procedure set out in the Mental Capacity Act (MCA)
2005 must be followed. For further guidance regarding consent please read Bradford
and Airedale Community Health Services ‘Consent to Examination and Treatment
Policy’ available at:
http://nww.bradford.nhs.uk/extranet/Policies/Published%20Policies/Consent%20to%20E
xamination%20and%20Treatment.pdf
4.7.4.1. The Mental Capacity Act 2005
Full information regarding the Mental Capacity Act (MCA) can be found in NHS
Bradford and Airedale clinical guideline ‘Mental Capacity Act 2005’ available at:
http://nww.bradford.nhs.uk/extranet/Policies/Published%20Policies/Mental%20Capa
city%20Act%202005.pdf
This Act came into force in 2007 and the law applies to everyone involved in care,
treatment or support of people aged 16 years or over in England and Wales who
lack capacity to make all or some decisions for themselves. There is an assumption
that people have the capacity to make decisions for themselves unless proved
otherwise. An assessment regarding capacity should be made and supported by the
use of a tick box checklist within the patient’s dental records (see appendix 8).
The law states that a person is unable to make a particular decision if they cannot
do one or more of the following:
• Understand information given to them
• Retain that information long enough to be able to make the decision
• Weigh up the information available to make the decision
• Communicate their decision – this could be done by talking, using sign
language or even simple muscle movements such as blinking an eye or
squeezing a hand.
Healthcare workers are able to diagnose conditions and carry out treatment for
patients who do not have capacity as long as they have complied with the MCA, and
are acting in the individual’s ‘best interests’
Protocol for Dental Care in a Domiciliary Setting v2 Page 9 of 50
©BACHS 2010

The following check list may be used to determine what is in the ‘best interests’ of a
person lacking capacity:
• Involve the person who lacks capacity
• Consult with others involved with the care of the person
• Do not make assumptions based solely on a person’s age, appearance,
condition or behaviour
• Be aware of the person’s past and present wishes and feelings
• Give consideration to whether the person is likely to regain capacity to make
the decision in the future
• The individual must be supported to make a decision as far as possible even
if it is what others may feel is an unwise decision
• The decision must be recorded in writing
4.8. Subsequent appointments
At subsequent appointments the following should be checked to ensure no changes have
taken place, and therefore treatment can proceed:
• Risk assessments
• Consent and capacity to consent
4.9. Completion of treatment
At completion of treatment the patient or carer is provided with a copy of the patients ‘oral
health care plan’. This is a duplicate form, completed by the dentist recommending the
individual’s care plan to maintain oral health (Appendix 12). The review or recall period will
be documented on this form in accordance with NICE guidelines (National Institute of
Health and Clinical Excellence 2004).
5. Special considerations when undertaking domiciliary care
Undertaking treatment in patients’ homes or care homes means additional factors need to be
taken into consideration. The normal facilities of the dental surgery are not present and
therefore it is essential that the following are taken into consideration when assessing and
treating patients outside the clinical setting.
5.1. Infection Control
Infection prevention management within the domiciliary environment must be maintained. If
the environment prevents this, treatment must be delivered from another appropriate setting
or a formal infection control risk assessment should take place and reasonable adjustments
made that do not compromise the safety of patients, staff, carers or the legal obligations of
the organisation or individuals.
For further information please consult the Bradford and Airedale Community Health
Services ‘Infection Control Management Policy’ available at:
http://nww.bradford.nhs.uk/extranet/Policies/Published%20Policies/Infection%20Prevention
%20Management.pdf
5.2. Medical emergencies in the domiciliary setting
Medical emergencies can occur and at any time in premises where dental treatment takes
place. The nature of the patients being treated in a domiciliary setting means that there
could be a greater chance of encountering a medical emergency. All staff undertaking
treatment in patient’s homes must ensure they are trained and competent in dealing with
Protocol for Dental Care in a Domiciliary Setting v2 Page 10 of 50
©BACHS 2010

collapsed patients. The following equipment must be available for use when assessing and
treating patients in the domiciliary setting:
• Portable suction apparatus to clear the oro-pharynx
• Oral airways to maintain the natural airway
• Ambu-bag and face masks
• A portable source of oxygen
• An emergency drug kit
• Portable Automated External Defibrillator (AED)
• Mobile phone to ensure emergency services can be contacted
For further information please read Bradford and Airedale Community Health Services
‘Resuscitation Policy and Procedures for Adults, Children and Infants’ available at:
http://nww.bradford.nhs.uk/extranet/Policies/Published%20Policies/Resuscitation%20for%
20Adults,%20Children%20and%20Infants.pdf
5.3. Health and Safety
Health and Safety standards must be maintained within the domiciliary environment and a
formal risk assessment must be carried and document at the initial visit. Risk assessments
must be reviewed and updated at each visit.
All Health and Safety issues must be assessed with particular emphasis on:
• Lone working (Appendix 13)
• Environment
• Manual Handling people and equipment (Appendix 14)
• Vehicle Insurance
• Emergency equipment including oxygen (Appendix 15)
• Chaperoning
Further details are included where indicated above.
Please consult the following documents for more information:
NHS Bradford and Airedale Health and Safety Policy
http://nww.bradford.nhs.uk/extranet/Policies/Published%20Policies/Health%20and%20Safet
y.pdf
NHS Bradford and Airedale Manual Handling Policy
http://nww.bradford.nhs.uk/extranet/Policies/Published%20Policies/Manual%20Handling%2
0-%20App10d%20Risk%20Assessment%20Form%20V1.pdf
NHS Bradford and Airedale Lone Working Policy
http://nww.bradford.nhs.uk/extranet/Policies/Published%20Policies/Lone%20Working.pdf
6. Procedure for requests for new dentures which have been lost in the Hospital/Care
home
The procedure for re-making dentures which have been lost by a care home is explained in
Appendix 16.
The replacement appliance refund claim form for patients is included in Appendix 17
Protocol for Dental Care in a Domiciliary Setting v2 Page 11 of 50
©BACHS 2010

7. References
Bradford and Airedale Salaried Dental Service, 2009 Advanced Treatment Protocol
Bradford and Airedale NHS Infection Prevention and Control Management Policy (2007)
British Society for Disability and Oral Health: Guidelines for the Delivery of a Domiciliary Oral
Healthcare Service August 2009
Department of Health Implementing Local Commissioning For Primary Care Dentistry
Factsheet 7: Commissioning out-of-hours services Gateway Reference 5917
Department of Health and the British Association for the Study of Community Dentistry
Guideline 2009. Delivering Better Oral health: An evidence-based toolkit for prevention
(283540) [internet] 2nd Edition Published April 2009 Available at
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/
DH_102331 [accessed 1st October 2010]
General Dental Council Standards for Dental Professionals 2009. http://www.gdcuk.org/NR/rdonlyres/1B66D814-A197-4253-B331-
A2DB7F3254DC/0/StandardsforDentalProfessionals.pdf [accessed 1st October 2010]
Joint Formulary Committee September 2008 British National Formulary 56 BMJ Group London
Mental Capacity Act. Department of Health 2005
http://www.dh.gov.uk/en/SocialCare/Deliveringsocialcare/MentalCapacity/MentalCapacityAct20
05/index.htm [accessed 1st October 2010]
National Institute of Health and Clinical Excellence 2004 Dental recall – Recall interval between
routine dental examinations
http://www.nice.org.uk/nicemedia/live/10952/29488/29488.pdf [accessed 1st October 2010]
Protocol for Dental Care in a Domiciliary Setting v2 Page 12 of 50
©BACHS 2010

Appendix 1 – Care pathway for domiciliary care
Protocol for Dental Care in a Domiciliary Setting v2 Page 13 of 50
©BACHS 2010

Appendix 2 – Bradford and Airedale Salaried Dental Service Referral form
Protocol for Dental Care in a Domiciliary Setting v2 Page 14 of 50
©BACHS 2010

Protocol for Dental Care in a Domiciliary Setting v2 Page 15 of 50
©BACHS 2010

Appendix 3 – Eligibility assessment for Domiciliary Care
Protocol for Dental Care in a Domiciliary Setting v2 Page 16 of 50
©BACHS 2010

Appendix 4 – Decision–making process for Domiciliary Care
Protocol for Dental Care in a Domiciliary Setting v2 Page 17 of 50
©BACHS 2010

Appendix 5 – Pre-appointment questionnaire
Protocol for Dental Care in a Domiciliary Setting v2 Page 18 of 50
©BACHS 2010

Protocol for Dental Care in a Domiciliary Setting v2 Page 19 of 50
©BACHS 2010

Appendix 6 – Collecting patient charges on domiciliary visits
Protocol for Dental Care in a Domiciliary Setting v2 Page 20 of 50
©BACHS 2010

Appendix 7 – Domiciliary visit risk assessment form
Protocol for Dental Care in a Domiciliary Setting v2 Page 21 of 50
©BACHS 2010

Protocol for Dental Care in a Domiciliary Setting v2 Page 22 of 50
©BACHS 2010

Appendix 8 - Assessment of capacity form
Protocol for Dental Care in a Domiciliary Setting v2 Page 23 of 50
©BACHS 2010

Protocol for Dental Care in a Domiciliary Setting v2 Page 24 of 50
©BACHS 2010

Appendix 9 - Equipment list
Domiciliary kit
Organise in sub kits
These then are organised into red boxes or agreed appropriate boxes for transportation.
All boxes to be officially labelled with clinic details. Kits 1,2 and 3 would be required for
all domiciliary visits with addition of kits 4,5,6 and 7 as appropriate.
1. General kit
• Portable light/pen torch (with additional batteries)
• Latex-free gloves
• Alcohol gel hand rub
• Disinfectant wipes
• Face masks/visors
• Plastic aprons
• Protective eyewear for patient/bib
• Paper towels
• Tissues
• Napkins
• Clinical waste bags and appropriately labelled red box
• CSSD tote box for contaminated instruments, appropriately labelled.
2. Emergency kit
• Portable oxygen cylinder in purpose designed carrying case (hazard notice for
vehicle)
• Portable suction unit with appropriate sundries
• Emergency resuscitation equipment/drugs kit, including portable defibrillator
3. Administrative (in brief case if preferred)
• Identification badges
• Map/directions
• Patient records
• Laboratory forms
• Consent forms
• FP17DC forms
• PR11 forms
• Medical history forms
• Prescription sheet and stamp
• BNF
• Mobile phone
• Pens/pencils
• Appointment cards
• Change for parking
• List of contact numbers
• Health promotion literature
• Float
Protocol for Dental Care in a Domiciliary Setting v2 Page 25 of 50
©BACHS 2010

4. Basic exam kit
• Dental mouth mirror
• Dental probe
• Finger guard
• Periodontal probe
• College tweezers
• Pen torch with additional batteries
• Light source
• Hand mirror
• Vaseline
• Cotton wool rolls/pellets
• Gauze squares
• Toothbrushes
• Therapeutic agents: Chlorhexidine gel, fluoride varnish
5. Prosthetic Kit
• Basic exam kit– see 4
• Portable motor hand pieces and burs
• Safe air heater
• Disposable scalpel
• Willis bite gauge
• Indelible pencil
• Vaseline
• Impression materials
• Impression trays/fixative/mixing equipment
• Tissue conditioner
• Plastic bags/gauze squares for impressions
• Pressure relief paste
• Bite registration material
• Shade guide
• Articulating paper
• Dental waxes
• Wax knife
• Denture trimming kit
• Denture fixative
6. Conservation Kit
• Basic exam kit– see 4
• Conservation instruments - flat plastic, excavators and tray.
• Matrix strips/bands
• Motor hand piece and burs
• Light source
• Materials: Temporary dressing materials eg zinc oxide/eugenol cement, GIC,
Protocol for Dental Care in a Domiciliary Setting v2 Page 26 of 50
©BACHS 2010

7. Periodontal Kit
• Basic exam kit – see 4
• Hand scalers
• Portable motor handpiece and prophy cups/bristle brushes
• Periodontal probe
• Ultrasonic scaler plus tips
• Portable suction, aspirator tips and other associated sundries
These guidelines may vary at times but only at discretion of the dentist
Protocol for Dental Care in a Domiciliary Setting v2 Page 27 of 50
©BACHS 2010

Appendix 10 – Risk assessment for domiciliary Instruments
Protocol for Dental Care in a Domiciliary Setting v2 Page 28 of 50
©BACHS 2010

Appendix 11 – Manual handling risk assessment form
Protocol for Dental Care in a Domiciliary Setting v2 Page 29 of 50
©BACHS 2010

Protocol for Dental Care in a Domiciliary Setting v2 Page 30 of 50
©BACHS 2010

Appendix 12 – Oral health care plan
Protocol for Dental Care in a Domiciliary Setting v2 Page 31 of 50
©BACHS 2010

Appendix 13 – Lone Worker Security Procedure
Bradford and Airedale Salaried Dental Service
Lone Worker Security Procedure
All staff must be aware that they have a responsibility to protect their own personal
safety during working hours and must be familiar with and follow the guidance in
http://nww.bradford.nhs.uk/extranet/Policies/Published%20Policies/Lone%20Working.pdf
and Bradford Salaried Dental Service Domiciliary Procedure.
It is important that staff follow a structured security procedure when they;-
• Work in isolation.
• Carry out domiciliary visits.
• Deliver resources.
• Work in a community setting.
Security Procedure
1. A detailed risk assessment must be carried out for all initial visits. This risk
assessment must be reviewed and updated before staff carry out subsequent
visits.
2. Details of visits must be either placed on the R4 appointment book or in a visit
log. It is good practice to have a visual queue to remind colleagues that staff are
out on visits e.g. a whiteboard.
3. A responsible person in each clinic must be nominated before staff leave the
premises/ clinic i.e. dental receptionist, senior nurse or a colleague.
4. The responsible person must be informed of the details of staff visits with
estimated departure and return times.
5. Staff must leave the following information with the responsible person:-
• Mobile telephone numbers
• Car registration, make and model
6. Fully charged mobile telephones and personal alarms must be taken on all visits.
7. Any changes to scheduled visits must be reported to the appointed person
immediately and local records updated.
8. Staff working in a community setting (including out of hours) must inform a senior
member of staff (responsible person) of their proposed timetable.
Staff must inform the responsible person when they start and finish their shift.
This can be via text or they can ring the responsible person.
Protocol for Dental Care in a Domiciliary Setting v2 Page 32 of 50
©BACHS 2010

9. If staff do not return / or contact the responsible person within half an hour of their
estimated time the responsible person should try to contact staff on their mobile
telephone.
10. If staff can not be contacted the responsible person must trace the staff
movements by contacting each patient / client on the visit schedule.
11. If the responsible person can still not contact staff then they should contact their
manager and the police immediately.
12. Personal details for all staff will be available from the dental office or the senior
dental nurses offices at Horton Park.
13. If the responsible person is not working in the location for the duration of the
staffs visits they must hand over their responsibility to a colleague before they
leave.
Protocol for Dental Care in a Domiciliary Setting v2 Page 33 of 50
©BACHS 2010

Appendix 14 – Manual Handling Risk Assessment for handling domiciliary resources
Protocol for Dental Care in a Domiciliary Setting v2 Page 34 of 50
©BACHS 2010

Appendix 15 – Emergency equipment including oxygen carriage
Protocol for Dental Care in a Domiciliary Setting v2 Page 35 of 50
©BACHS 2010

Appendix 16 - Procedure for requests for new dentures which have been
lost/damaged in the Hospital/Care home
For patients who are exempt from dental charges: Process the examination and
denture construction as normal under a Band 3 treatment.
For patients who are not exempt from patient charges:
The construction of a new denture should be processed as a ‘Regulation 11
replacement’
On R4 when you open up the patient’s record, and choose examination type the box
‘Replacement appliance’ or ‘Two Replacement appliances’ should be ticked depending
on whether one or two dentures are being constructed.
One of the boxes
shown should be
ticked to indicate if
one or two dentures
are being replaced
A charge will be generated on the treatment plan; £59.40 for a single denture, £118.80
for two dentures.
If the denture was not lost or damaged due to lack of reasonable care by the patient they
are able to claim a refund for the denture/s from the Business Services Authority by
completing form FP17 R/11 which is included in Appendix 15.
Copies of the refund form can be printed from:
http://www.nhsbsa.nhs.uk/DentalServices/Documents/DentalServices/FP17R11_FRONT
_271008.pdf
Protocol for Dental Care in a Domiciliary Setting v2 Page 36 of 50
©BACHS 2010

Appendix 17 - Copy of FP17 R/11 form
Protocol for Dental Care in a Domiciliary Setting v2 Page 37 of 50
©BACHS 2010

Protocol for Dental Care in a Domiciliary Setting v2 Page 38 of 50
©BACHS 2010

Appendix 18 - Equality Impact Assessment Tool
Guidance
NHS BRADFORD AND AIREDALE
Equality Impact Assessment Toolkit
STAGE ONE
SCREENING/TESTING FOR RELEVANCE
An equality impact assessment is a way of systematically assessing, and
consulting on the effects that a proposed policy, strategy, tender or procedure is
likely to have on a diverse range of communities and individuals in the District.
The principles that underpin the Equality Impact Assessment process are those that
promote inclusion and meaningful participation. They are directed towards making a
sustained effort at eliminating inequitable health outcomes and eradicating unfair
treatment. The ability to treat all users and staff with respect and dignity, and provide
them with choices that are responsive and appropriate is a fundamental requirement of
the Human Rights Act 1998
Stage 1 of the screening applies to all policies, strategies, tenders, or procedures.
The aim of this is to test the relevance of impact against the equality target
groups. In stage 1 available data will be interrogated, relevant research will be
consulted together with any anecdotal feedback that may help form an opinion about the
impact a policy, strategy, tender or procedure may have on any of the equality target
groups.
Gathering evidence is a key to assessing progress and defining expected equality
outcomes. Where data is limited or not available reviewers should identify this as a
limitation and schedule this as further evidence needed. The legal duties require policy
authors to use information/ data to determine the effect of the policy on equality and
diversity. Previous data used to monitor the policy can be used in support of this element
of the review. Data can be statistical or qualitative information from audits and
consultation exercises.
Consultation and engagement is required at all stages of policy development.
This stage involves screening the policy, strategy, tender or procedure for relevance
against the equality target groups. If you require further assistance you should contact
the Equality and Diversity Team:
Protocol for Dental Care in a Domiciliary Setting v2 Page 39 of 50
©BACHS 2010

NHS Bradford and Airedale Equality Impact Assessment Flowchart
Conduct a FULL
EQIA
You will need to change this policy, practice
or procedure so that any adverse impact is
removed
In its design or implementation stage, does it
intentionally or unwittingly discriminate
against particular groups of people, e.g., men,
women, disabled people, people from different
ethnic groups and religions, age groups, and
sexual orientation?
YES UNCERTAIN NO
Ask those most affected, and
consult relevant staff, patients,
VCS, and other users
HOW DO YOU
KNOW?
Data
Staff
Users
Scanning
No need to change this
policy at present, though
remember to keep it under
review.
Protocol for Dental Care in a Domiciliary Setting v2 Page 40 of 50
©BACHS 2010

Stage One: Screening of a policy, procedure, tender or a strategy
• 1. Name of policy, procedure, tender or
strategy
Protocol for dental care in a domiciliary setting
• Is it a policy, strategy, procedure or
Protocol
practice?
• 2. Main Aims
Safe treatment of patients in the domiciliary setting
• 3. Who has been consulted?
Based on national document
• 4. How has the policy been explained to those most
N/A
likely to be affected?
Protocol for Dental Care in a Domiciliary Setting v2 Page 41 of 50
©BACHS 2010

Collecting and collating existing information and data
Please indicate in the table below whether the policy, strategy, procedure or tender has the potential
to impact adversely on the equality target groups
Equality Target Group
1. Is the policy
likely to have a
potential differential
impact with regards
to the equality
target group listed?
O = No
1 = Little
2 = Medium
3 = High
2. How have you arrived at the conclusions in box 1?
i. Who have you consulted? (appropriate
individuals/groups internally and externally)
ii. What have they said?
iii. What information/data have you interrogated?
(library search, complaints data, PALS, research
reports, local studies, advice from internal and
external specialists)
iv. Where are the gaps in your analysis?
v. How will your paper promote the equality duties
if they apply?
There have been no concerns expressed to the SDS about the access criteria for domiciliary care, where possible we do
try to assess patients in their homes but as we are very restricted on what can be done outside the surgery patients do
understand that they have to come in for at least some of their care.
If a referral is received for domiciliary care we generally do an initial assessment so we can ascertain which level of care
is appropriate for the patient. If a patient can come in we would do the assessment in the clinic but some treatment items
may be carried out in patient’s homes.
We have a current programme of patient involvement with groups that would use the service such as nursing homes
and learning disabilities groups and this is to promote the service. There have been no access problems reported.
Age
Disability
Gender
Older people
Young people
Children
Early years
Sensory
disabilities
Physical
disabilities
Learning
disabilities
Mental health
Men
Women
Transgender
0
0
0
No adverse affect - Mainly elderly/infirm patients
that would access this service
No adverse effect – Service has a positive impact
on patients with disabilities unable to access
regular dental care
All patients have equality of access to this service
Protocol for Dental Care in a Domiciliary Setting v2 Page 42 of 50
©BACHS 2010

Race
Religion or
Belief
Sexual
Orientation
Summary
Minority
Ethnic
Communities
Gypsies &
Travellers
Christian
Muslim
Hindu
Buddhist
Sikh
Jew
Other
Lesbian
Gay men
Bisexual
8) Is a more Full Equality
Impact Assessment
Required?
0
0
0
All patients have equality of access to this service
All patients have equality of access to this service
All patients have equality of access to this service
No Yes
9) Please describe the main points arising from the initial screening here
that support your decision in box 8
This protocol is for domiciliary dental treatment and does not adversely
affect equality of access or treatment
Response to main action points:
1. Signature of Policy Lead conducting impact assessment: Lucie Godber
2. Approved by Equality and Diversity Lead: Lynne Carter
Date: 13.10.10
Protocol for Dental Care in a Domiciliary Setting v2 Page 43 of 50
©BACHS 2010

Appendix – 19 Checklist for the Review and Approval of Documents
Individual Approval
If you are happy to approve this document, please sign and date it and forward to the chair of the
committee/group where it will receive final approval.
Name Lucie Godber Date Aug 2010
Signature Lucie Godber
Committee Approval
If the committee is happy to approve this document, please sign and date it and forward copies to
the person with responsibility for disseminating and implementing the document and the person who
is responsible for maintaining the organisation’s database of approved documents.
Name Date
Signature
Acknowledgement: Cambridgeshire and Peterborough Mental Health Partnership NHS Trust
Protocol for Dental Care in a Domiciliary Setting v2 Page 44 of 50
©BACHS 2010

Appendix 20 - Document Review
1. Title
Title of document being reviewed:
Yes/No/
Unsure
Is the title clear and unambiguous? Yes
Is it clear whether the document is a guideline,
policy, protocol or standard?
2. Rationale
Are reasons for development of the document
stated?
3. Development Process
Is the method described in brief? No
Are people involved in the development
identified?
Do you feel a reasonable attempt has been
made to ensure relevant expertise has been
used?
Is there evidence of consultation with
stakeholders and users?
4. Content
Yes A protocol
Yes In introduction
Comments
Protocol for Dental Care in a Domiciliary Setting v2 Page 45 of 50
©BACHS 2010
No
Yes
No
Is the objective of the document clear? Yes
Is the target population clear and
unambiguous?
Yes
Are the intended outcomes described? Yes
Are the statements clear and unambiguous? Yes
5. Evidence Base
Is the type of evidence to support the
document identified explicitly?
Yes

Title of document being reviewed:
Yes/No/
Unsure
Are key references cited? Yes
Are the references cited in full? Yes
Are supporting documents referenced? Yes
6. Human Resources
If appropriate have the joint Human
Resources/staff side committee (or equivalent)
approved the document?
7. Summary of Guidance
Is there a quick reference guide, key
recommendations or flow chart summarising
the document?
(not obligatory, but may be helpful for some
documents)
8. Format
Comments
Protocol for Dental Care in a Domiciliary Setting v2 Page 46 of 50
©BACHS 2010
N/a
N/A
Is the document in an easily readable font? Yes
Is there an appropriate footer on each page? Yes
Is it easy to find sections within the document? Yes
9. Patient Information
Does the document require patient
information? If so, does it make clear what
information and how this should be presented?
9. Dissemination and Implementation
Is there an outline/plan to identify how
dissemination and implementation will be
done?
Yes
Yes

Title of document being reviewed:
Does the plan include the necessary
training/support to ensure compliance?
9. Process to Monitor Compliance and
Effectiveness
Are there measurable standards or KPIs to
support the monitoring of compliance with and
effectiveness of the document?
Is there a plan to review or audit compliance
with the document?
11. Overall Responsibility for the Document
Is it clear who will be responsible for co-
ordinating the dissemination, implementation
and review of the document?
Yes/No/
Unsure
Comments
Protocol for Dental Care in a Domiciliary Setting v2 Page 47 of 50
©BACHS 2010
N/A
N/A
Yes
Yes

Appendix 21 - Plan for dissemination of documents
Title of document:
Date finalised:
Previous document
already being used? Yes
If yes, in what
format and where?
Proposed action to
retrieve out-of-date
copies of the
document:
To be disseminated
to:
Staff of Salaried
Dental Service
Bradford and Airedale Salaried Dental Service Protocol for Dental
Care in Domiciliary Setting
Paper format in clinics
Dissemination lead:
Print name and contact
details
Will recall through Clinical Rep Group
How will it be
disseminated, who
will do it and
when?
Quality and Governance
Group
Professional and Clinical
Development meeting
Via operational update
Paper
or Electronic
Both
Comments
On K drive and on PCT
Policy Library
Protocol for Dental Care in a Domiciliary Setting v2 Page 48 of 50
©BACHS 2010

Appendix 22 - Dissemination Record -
Date put on register of
documents
Disseminated to:
(either directly or
via meetings, etc)
Format (i.e.
paper or
electronic)
Date
Date due to be
reviewed
Disseminated
No. of
Copies
Sent
Contact Details /
Comments
Protocol for Dental Care in a Domiciliary Setting v2 Page 49 of 50
©BACHS 2010

Appendix 23 - Summary of Policy Development and Consultation
This protocol has been developed by the Bradford and Airedale Salaried Dental Service
Quality and Governance Group. The group consists of the following members:
Bradford and Airedale Salaried Dental Service Clinical Director
Assistant Clinical Director
Specialist in Paediatric Dentistry
Senior Dentist (Adult Special Care)
Operations managers
Oral Health Promotion Manager
Members of the dental team who undertake domiciliary care have been instrumental in
the development of the protocol alongside the wider dental team involved in Adult
Special Care.
Protocol for Dental Care in a Domiciliary Setting v2 Page 50 of 50
©BACHS 2010