Transforming and Supporting Patient Care - Health Professions ...

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218Chapter 9 – Profession of DentistryUnder the RCDSO Guidelines, only dentists, physicians, or nurses orrespiratory therapists acting under the order and direct control of thedentist or physician may administer any sedative or general anaestheticagent in the dental setting. In addition to the general guidelines, additionalprofessional responsibilities apply when nitrous oxide and oxygenconscious sedation or other forms of sedation and anaesthesia is beingadministered. 12Unauthorized use of nitrous oxide by members or staff has been raised as afitness to practise concern. The safeguarding of supplies and nitrous oxideequipment and preventative strategies is a key requirement of the practiceguidelines.The RCDSO offers an on-line Adverse Drug Interactions Program to providetimely and reliable information on drugs. Dentists are able to list themedications their patients are taking and receive information aboutpossible drug interactions, along with citations pertinent to druginteractions. A reference index, updated every six months, of over 3,000drugs by brand names with generic equivalents is also provided. Thisservice is made available by The Medical Letter, a New York-based,independent, peer-reviewed, nonprofit publication that offers criticalevaluations of drugs, with special emphasis on new drugs, to members ofthe health professions. 13What Other Leading Jurisdictions DoHPRAC’s jurisdictional review indicates that British Columbia, Alberta,Quebec and Saskatchewan have regulations listing schedules of drugs thatdentists in their respective jurisdictions can prescribe. None of theseprovinces includes specific classes or categories of drugs. 14 In otherprovinces, such as Manitoba and Nova Scotia, guidelines and by-laws areused to outline the use of anaesthesia and sedation. 15In Great Britain, there is a list of preparations approved for dentalprescribing posted on the Department of Health website. 16 However, recentconversations with the Department of Health Non-Medical PrescriberProgram and National Prescribing Centre indicated that Great Britain ismoving away from specific lists of drugs for many professions, in favour of aframework where the practitioner must demonstrate competence toadminister and prescribe drugs within their professional scope of practice.ConclusionsHPRAC concurs that the profession of dentistry has the knowledge and12Ibid.13RCDSO. The Medical Letter. www.rcdso.org/medical_letter.html.14HPRAC. Prescribing and Use of Drugs by Non-Physician Health Professionals: A JurisdictionalReview of the Profession of Dentistry. November 2008.15Ibid.16Department of Health. List of preparations approved for dental prescribing. March 2005.www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4112074? IdcService=GET_FILE&dID=23203&Rendition=Web.HPRAC Critical Links January 2009
219Chapter 9 – Profession of Dentistrycompetency in pharmacotherapy, and a record of safe prescribing practiceswhich justifies maintaining open prescribing rights. HPRAC does not see abenefit to increased public protection in moving to classes of drugs thatwould be authorized in regulations under the Dentistry Act, 1991. HPRACtherefore supports the profession’s continued access to open prescribing.In order to bring dentistry in closer alignment with other health professions,HPRAC is recommending that the RCDSO formalize standards of practicethrough the creation of an interprofessional Dentistry Standards Committee.Increased flexibility is balanced with an enhanced role for the RCDSO tomore actively and rigorously regulate the profession in the public interestand ensure appropriate accountability measures to protect the public.HPRAC is aware that this will mean a formalization of existing practices forthe profession in some circumstances, but will also allow for the opening ofnew options in the development of standards of practice.HPRAC is also aware that the profession of dentistry, despite interventionsand proposals to the Ministry over a number of years, lacks a qualityassurance regulation and has attempted to guide quality improvementwithin the profession on the basis of policies, rules and guidelines. Whilethere are reasons for the approach taken by the RCDSO, HPRAC would liketo see early initiatives to establish quality assurance regulations under theDentistry Act, 1991 to provide clarity to the public, the profession and otherhealth professions. RCDSO leadership, with a collaborative approach to thedevelopment of interprofessional standards of practice and qualityassurance programs could provide a major impetus for progress ininterprofessional care.HPRAC also recommends that regulation provisions be amended to includethe authority to make regulations for prescribing, selling and compoundingof drugs, rather than the current regulations that refer to dispensing only.Standards of practice developed by the RCDSO would have legal authorityas a result of the regulation. As with recommendations for otherprofessions, HPRAC recommends that dentists be held accountable in theircertificates of registration to comply with standards of practice forprescribing, dispensing, selling and compounding of drugs.HPRAC has concluded that since Ontario dentists have access to controlleddrugs and substances under federal statutes and regulations, professionalmisconduct regulations should be expanded to include contraventions ofother laws and the loss of privileges under the Controlled Drug andSubstances Act (Canada) or privileges under the Food and Drugs Act(Canada) as with other professions in this review.Section 50 of Ontario Regulation 547 under the Drug and PharmaciesRegulation Act (DPRA) gives dental hygienists authority to performHPRAC Critical Links January 2009
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20Chapter 2 - Excellence in Health
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56Chapter 3 - A New Drug Approvals
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164Chapter 7 - Professions of Chiro
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310Chapter 13 - Profession of Optom
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340Chapter 14 - Profession of Pharm
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378Chapter 16 - Profession of Respi
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396Chapter 17 - Conclusionsincluded
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398Chapter 18 - Summary of Proposal
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