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ADH - Professional Practice > Direct Access & Consent > Flashcards

Direct Access & Consent Flashcards

1
Q

Impact of direct access on a registrants scope of practice and its effect on the dental team

A

Direct access changed in 2013

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2
Q

Direct access GDC decision 2013 - what does it mean?

A

Dental h&t can carry out full scope of practice except tooth whitening without needing a prescription from a dentist

Option for direct access if h&t would like

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3
Q

GDC advice of h&t experience

A

No requirement for experience for treatment direct for pt

However, a period after qualification of practicing on prescription will help build experience / confidence

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4
Q

All General Dental Council registrants have to be trained, competent and … for the work they do

A

indemnified

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5
Q

July 2016 GDC declaration for Indemnity prior to annual …

A

registration

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6
Q

POM Prescription only medicines :

A

POM Prescription only medicines : local anaesthetic, duraphat varnish, duraphat toothpaste

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7
Q

Patient group directive PGD

A

Practice has umbrella of h&t ‘s prescribing and part of the treatment

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8
Q

Patient specific directive PSD

A

Medications written into treatment plan

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9
Q

For DCP’s there is a requirement for delivering POM’s
- in emergency…
- human medicine act recognises…
- when working under direct access…

A
  • in an emergency it would not be on a tx plan
  • human medicine act 2012 recognises any DCP who has training can administer POM to save pt life
  • when working under direct access, a dentist would be req to purchase and prescribe within the practice the POM’s (this is a barrier to h&t’s running their own practice under direct access)
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10
Q

Another limitation for h&t direct access?

A

NHS limitations within primary care trust

h&t currently don’t have access to performer numbers - therefore limitation to direct access

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11
Q

Tooth whitening

A

Tooth whitening
To the prescription of a dentist under direct supervision Dentist must see patient for the first appointment
European regulations
Inform indemnity of carrying out
Tooth whitening

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12
Q

Kevin Lewis Dental Director Dental Protection 2015

A

“The introduction of Direct Access has not increased the number of complaints made by the public to the dental regulator about hygienists and therapists, but ,naturally the GDC did receive a substantial number of queries”

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13
Q

Radiography
Limitation to h&t?

A

Radiography h&t can
Referrer
Operator
Practitioner

REPORTER - only by referring dentist

Scope of Practice - prescribing radiographs

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14
Q

General Dental Council Standards

A

ITS advised that

6.2.2 you should work with another appropriately trained member of the dental team at all times when treating patients in a dental setting

Exceptional circumstances

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15
Q

GDC
GDC Standard 2013 Principal six

A

GDC Standard 2013 Principal six
6.3 You must delegate and refer appropriately and effectively
6.3.3 You should refer patients on if the treatment is outside
your scope of practice or competence
Clear arrangements in place for transfer, referrals
and communication

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16
Q

GDC standards

A

7.2.2 You should only deliver treatment and care if you are confident that you have had the necessary training and are competent to do so. If you are not confident to provide treatment, you must refer the patient to an appropriately trained colleague.

How to write a referral letter? Referring patients whilst working under Direct Access

17
Q

J. King Staged approach to informed consent – Adapted to the10 steps !

A
  1. Purpose of the visit
    – explain the findings
    – utilise visual aids
  2. Establishing what is already understood
    – Involve the patient in the process
    - invite information to understand what they already know
  3. Explain the nature of the clinical condition
    – use clear, simple, jargon free language
  4. Outline treatment options
    – provide written and illustrated information sheets to take home and allow further consideration
    – allow time for patients to reflect on their choices
  5. Explain risks and benefits
    – what do you do if you have the preferred treatment
    – what happens if you don’t choose this
  6. Checking what has been understood
    – ask the questions to confirm understanding
    – ask the patient to summarise
  7. Invite further questions
    – invite questions to allow patients to express anything they are unclear, or concerned about, or wish to confirm
  8. Confirming the preferred treatment options, the risks and benefits
    – ask if the patient needs more time or information to reflect.
  9. Obtain confirmed consent respecting patient autonomy
  10. Record consent in patient records
18
Q

Consent

A

Valid Consent
Informed – Valid Consent?
Gillick /Fraser competence
Interpreters /Language barriers
Mental Capacity Act

19
Q

Safeguarding

Mental Capacity Act 2005 enacted 2007

A

Mental Capacity Act 2005 enacted 2007 - 5 key principles

Every adult should be assumed to have the capacity to make a decision unless it is proved otherwise

The right for individuals to be supported to make their own decisions

Individuals retain the right to make unwise decisions

Anything done is in the patients best interests
Least restrictive intervention must be considered when gaining consent - 2 stage test
1. Stage 1 -Is there impairment ?
2. Alcohol ,drug use, delirium ,concussion ,learning disability, brain injury, stroke, mental illness, dementia, confusion , drowsiness, Medical impairment
- Stage 2 Assessment

20
Q

5 principles which underpin the mental capacity act

A
  1. Always assume pt has capacity unless proven otherwise
  2. Take all practicable steps to enable people to make own decisions
  3. Do not assume incapacity because someone makes an unwise decision
  4. Always act or decide for a reason without capacity in their best interest
  5. Carefully consider actions to ensure the least restrictive option is taken
21
Q

Montgomery v Lanarkshire 2015

Mrs Montgomery “was not able to make a fully informed decision without full information on all the options “

A

Ensure that all proposed care and treatment for the consent process is tailored to the individual needs of the patient

22
Q

Montgomery v Lanarkshire 2015 outcome

Royal College of Physicians

A

The law on consent has progressed from doctor focused to patient focused. The practice of medicine has moved significantly away from the idea of the paternalistic doctor who tells their patient what to do, even if this was thought to be in the patient’s best interests. A patient is autonomous and should be supported to make decisions about their own health and to take ownership of the fact that sometimes success is uncertain and complications can occur despite the best treatment.

23
Q

10 commandments MDU J.Duffy Judicial Assistant during Montgomery argument 2015

A

1.Make full notes to document the consent process,do not rely solely on a consent form

  1. Discuss reasonable alternatives –where appropriate , these include the options of having no treatment at all
  2. Ensure adequate time is set aside – this is easier said than done, a meaningful consent process based around a real dialogue requires more time
  3. Focus on the individual patient .Is it clear that you have taken steps to understand concerns and wider circumstances – is there reference to medical conditions , psychological state , family circumstances?
  4. Engage in a 2 way dialogue- record both sides of the conversation
  5. Do not focus on percentages – Post Montgomery , the scientific magnitude of risk is only a factor and should not determine what risks are discussed
  6. Consider the risks of intervening events not just catastrophic outcomes – this may include distressing, painful or dangerous intervening events
  7. Think carefully before relying on the therapeutic exception /patient autonomy
  8. Patient understanding – is it clear that the patient fully understood the advice given ?
  9. Leafleting is not enough – bombarding a patient with information does not discharge the duty of consent
24
Q

How to protect pt and ourselves when gaining consent

A

You must give patients a written treatment plan…you should also ask patients to sign a treatment plan

A treatment plan must include: proposed treatment and cost

25
Q

Treatment plans - giving the patient a written plan of proposed treatment with costs.

A

2.2.2 you should encourage patients to ask questions about their options…..2.3.5 make sure patients have enough information and enough time to ask questions and make a decision

26
Q

Principle Seven
Maintain, develop and work within your professional knowledge and skills

A

Principle 7.1 you must provide good quality care based on current evidence and authoritative guidance
7.1.2 if you deviate from established practice and guidance,you should record the reasons why and be able to justify your decision

ADH - Professional Practice (1 decks)

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