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

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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
Page 1 and 2: Protocol for Dental Care in a Domic
Page 3 and 4: Appendices Appendix Topic Page 1 Ca
Page 5 and 6: 1. Introduction The strategic direc
Page 7: appointment questionnaire (Appendix
Page 11 and 12: collapsed patients. The following e
Page 13 and 14: Appendix 1 - Care pathway for domic
Page 17 and 18: Appendix 4 - Decision-making proces
Page 21 and 22: Appendix 7 - Domiciliary visit risk
Page 23 and 24: Appendix 8 - Assessment of capacity
Page 25 and 26: Appendix 9 - Equipment list Domicil
Page 27 and 28: 7. Periodontal Kit • Basic exam k
Page 29 and 30: Appendix 11 - Manual handling risk
Page 31 and 32: Appendix 12 - Oral health care plan
Page 33 and 34: 9. If staff do not return / or cont
Page 35 and 36: Appendix 15 - Emergency equipment i
Page 37 and 38: Appendix 17 - Copy of FP17 R/11 for
Page 39 and 40: Appendix 18 - Equality Impact Asses
Page 41 and 42: Stage One: Screening of a policy, p
Page 43 and 44: Race Religion or Belief Sexual Orie
Page 45 and 46: Appendix 20 - Document Review 1. Ti
Page 47 and 48: Title of document being reviewed: D
Page 49 and 50: Appendix 22 - Dissemination Record

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