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THE PATIENT'S JOURNEY

The Patient’s Journey

I have been working with Niall Jennings, collecting references and listening to colleagues needing assistance. We have been trying develop a way to help.

The Patients Journey and Covid-19

The problems that we have come up against are, due to the absence of specific guidelines in relation to exactly what our duties of care and responsibilities are to our patients. There is a lack of the specific protocols that need to be put in place, in order to provide comprehensive dental care for our patients in this new environment

So effectively what we have to do at the moment, is to extrapolate from the multiple recommendations worldwide and try to use our professionalism, our moral courage and common sense, to develop valid guidelines for the treatment of patients. Clearly these will have to satisfy existing IDC, HIQA, and HSE protocols, as well as deal with the fallout from the present pandemic with Covid-19. In simple terms, we have to address the effect of the aerosol that we produce in the practice of modern Dentistry.

Covid-19 and modern Dentistry creates a situation where our patients, our staff, ourselves and the premises which we work in, all need to be reassessed in terms of the potential transmission of the Virus and the ability of this virus to cause disease, and possibly death. We need to take into

consideration all of the above and look at the way each has to be controlled in order to prevent the transmission and spread of Covid-19. So, the question is what do we do and where do we go from here on the Patients Journey.

THE PATIENT

The patient will be going on a journey from the time they make a decision to seek dental care. The Patient Journey is significant and unique, with high standards expected from the dedicated professionals looking after them from the first phone call to the completion of successful treatment. This journey should be followed and used as a road map in preparing our practices for our new modern era of dentistry

Telephone Triage – Complete Medical, COVID-19 and Dental History by phone

Arrival Information – Safe and timely arrival, further triage confirmation, treatment preparation including the taking of our patients temperature, the use of mouth rinse, nose spray, hand washing head and foot protection

  • Multiple forms regarding explanations, understanding and consent, must be understood and be signed. Forms such as Medical Health, Patient’s Dental History, Covid-19 multiple questions to include consent and proposed treatment plans.
  • Mouth rinsing (pre-treatment oral mouth rinse) and nasal spray There are suggestions to show that these can diminish the presence of the virus in infected people. What can they prevent and should we be using them?
  • Our patients must be made fully aware of their own risk, and the risk we are taking with the responsibility we have carrying out any treatment. Informed Consent is essential.

THE PREMISES

  • Social distancing, social separation with screening, easy to clean surfaces with the availability of disinfectants.
  • Waiting rooms if used need to be kept simple and devoid of materials which cannot be easily disinfected.
  • Chairs can be covered with disposable covers. The beginning of the vast pile of potentially contaminated waste.
  • Toilets will need secure closed disposal units for waste.
  • Clear instructions and dialogue between staff and patients.
    The instructions will involve advice about the detailed protocols that are in place.
  • Adequate signage and warnings
  • Constant surveillance and disinfecting will need to be carried out.
THE SURGERY, STERILIZATION & DISINFECTION

Is it ready for the patient?

HIQA & HSE Protocols

  • The surgery must be stripped of all unnecessary equipment and furnishings.
  • The operative area needs to be isolated with as much separation as can be fitted.
  • All equipment needs to be cleaned/disinfected /sterilized and have the ability to be cleaned or isolated with removable disposable covers.
  • All instruments need to be available before treatment commences in a way that minimises unnecessary movement. This to prevent the need to access drawers and cupboards.
  • Controlled Contamination
  • Each treatment procedure will need to be audited to see if each can be effectively carried out given the significant constrained space and movement, due to the necessary wearing of PPE.
  • Cleaning and preparation for the next patient may need adjustments carried out to existing configurations in surgeries
  • Validation in the use of peroxides, hypochlorite or other suggested disinfectant and sterilization remedies must be clarified. See attachments
THE AEROSOL
  • Understanding of the Covid-19 containing aerosol is far from fully comprehended. We will need to understand the available chemicals, evacuation procedures and control of air movement, extraction, and purification.
  • Decisions on what systems we use and how we control them will involve research and
    accurate and supported verification for the different methods and materials which are currently available.
  • Until this happens a significant amount of what we have regarded as routine dentistry may well be curtailed.
  • Significant time and financial investment will be needed to put in place all these protocols. Irish Dental Council, where are you please?
PERSONAL PROTECTIVE EQUIPMENT
  • There appears to be a universal acceptance of one standard, which appears to involve head, face, mouth, nose, eyes, hands, body and footwear components for Dentist and Nurse.
  • Patients also will need more extensive coverage to eliminate ultimate dispersal of the aerosol back outside the surgery.
STERILISATION AREA
  • The system of validation, separation, washing, ultrasonic, heat washing, bagging and sterilisation has been with us for some time but accurate records of everything will become more important now and going forward i.e. HIQA
DISPOSAL
  • There are many aspects to consider in relation to disposal, not least sourcing the correct most effective, and cost-effective materials to deal with the above and will involve ongoing investigation.
  • Capacity and safe storage will need to be upgraded.
  • It may be necessary to create a changing area.
COMMUNICATION – THE DENTAL TEAM
  • The first thing here will be the need for the team to fully understand what’s expected of them and to be trained in this changed and ever-changing environment.
  • The use of the Health Services educational programs will be essential in providing information and training.
  • Oversight without doubt will be essential and continual interaction between all staff members will be critical, now more than ever.
  • It is essential to keep the team informed at all times and in the loop of everything that is being done to make their job safer and the practice fit for purpose. Fail to prepare; prepare to fail.
COMMUNICATIONS – PATIENTS JOURNEY
  • Not only do we need to communicate with our team we need to communicate with our patients, both existing and potential. Patients now more than ever will be especially apprehensive and au courant when it comes to protection and having Dental treatment carried out.
  • What we communicate and the way in which we do it, will create many potential flash points and will require patience, tolerance and understanding.
  • Informed consent across the board is important so that everyone including ourselves and our team understand and follow the protocols that each practice puts in place to protect themselves our patients and the greater community. CONTACT TRACING

In relation to the Dental Practice itself I feel the problem revolves around THE AEROSOL, its origin, causation, spread, effect, control and elimination and the subsequent interaction with our PATIENTS JOURNEY.

WHAT IS CONTAINED IN THIS DOCUMENT IS OUR OPINION AND WE ADVISE YOU TO CARRY OUT DUE DILIGENCE, AND CROSS REFERENCE INFORMATION WITH IDC AND RELEVANT HEALTH AUTHORITY SOURCES.

Angus P Roche PositivePractice.ie

INSPIRED BY LIFE IN DENTISTRY APRIL 2020