Law, Ethics and Professionalism Flashcards
What is the aim of restraint? But, what must we consider?
- Removing the patients free will
- Permitting the operator to impose their will upon the patient
- Inhibit the patient from applying their own inhibitions
We must consider the medico-legal implication
What are the medico-legal issues concerning consent that we must consider?
- Duty of care
- Standard of practice
- Law
- Risk avoidance
- Management of critical incidents
What are the 9 standards for a dentist?
- Patient’s interest first
- Communicate effectively
- Consent
- Protect and maintain patient info
- Clear and effective complaints procedure
- Work the colleagues in a way in the patients best interests
- Maintain, develop and work within your professional knowledge and skills
- Raise concern if patients at risk
- Personal behaviour maintains patient’s confidence
What is the definition of the dentist’s duty of care?
To provide safe, effective dental care of a standard a patient has a right to expect from a reasonable dental; practitioner; that is an individual holding themselves out to be someone professing to have the skills that a reasonably competent dental practitioner would have
Procedures that are considered restraint? And, what is necessary before administration?
- GA and sedation
- Written consent is 100% needed
Can restraint be used in the dental practice?
- Use of restraint may be lawful; provided that it was reasonable restraint
- Reasonableness requires reference to accepted practice
Forms of planned restraint?
- Physical (for LA)
- Oral sedation
- IV sedation
- GA
- Surreptitious use of sedation
Process necessary to document, inform and perform restraint?
- How much and what restraint
- Comprehensive records
- Establish the need
- Have and follow the protocol
- Justify use
- Act in the patient’s best interest
Premises necessary to perform safe restraint?
- Access
- Surgery accomodation
- Recovery rooms
- Admin facilities
- Health and safety legislation
Staff qualifications and training for the safety to perform restraint?
Staff: - qualified
- registered
- trained
- in date
- under indemnity
Training: - pre GA/sedation procedure
- the procedure
- recovery
- emergencyEquipment necessary to perform safe restraint?
- Appropriate
- Availability
- Maintenance
- Documentation
The needs of a suitable protocol for a treatment?
- Difference between guidelines, procedures and protocols
- Available in surgery
- Understood
- Appropriate
- Fully understood
- Audited updated and developed
What must a clinical practice demonstrate to be acceptable in the eyes of the GDC?
- Duty of care
- Appropriate
- Diagnosis
- Treatment planning
- Risks
- Alternatives
- Justifications
- Consent
- Review
- CPD
- Resus training
- Staff training
- Records
What are the necessary assessment questions for use of all restraints?
- Separate appointment
- Can be performed by different person
- Assessor trained and competent
- Discuss fully with patient
- Discuss with colleague if in doubt
- Document everything
- Assess for treatment plan and treatment required
- Discuss risks and alternatives
- Write and duplicate referral letter
Contents of a referral letter?
- Name, address and contact details of referrer and patient
- Medical and dental history
- Reasons for sedation
- Risks and alternative described
- Written pre and post OP instructions given
What should records include and demonstrate?
- History
- Clinical exam
- Treatment plans
- Treatment carried out
- Problems
- Future treatments
What is included in the GDC’s definition of scope of practice for a dentist?
A set of skills and abilities each registrant should have
Additional skills that may develop after registration to increase your scope of practice
Understand your limits and don’t exceed them
Trained for medical emergencies
What is expected legally from us as dentists?
Ethics Professionalism Professional governance Law Confidentiality Consent Negligence Record Keeping Risk management Clinical governance Referral of patients Dealing with complaints Working well as a team Professional development Self appraisal
What can dental nurses do?
Maintain equipment Carry out infection prevention Record dental charting Mix dental biomaterials Chairside support Keep accurate patient records Prepare dental radiography Process radiographs Patient aid/advice Aid in medical emergency Make appropriate referrals
What can orthodontic therapists do?
Prepare teeth for orthodontic treatment Maintain equipment Insert passive removable orthodontics Insert removable appliances Remove fixed appliances Place auxiliaries Study models Make orthodontic appliance Fit headgear Fit facebow Take occlusal records Clinical photographs Place brackets and bands Place archwires Advice on appliance car Fit tooth separators Fit bonded retainers Carry out IOTN Make appropriate referrals Keep full records Give patient advice
What can dental therapists do?
• obtain a detailed dental history from
patients and evaluate their medical
history
• carry out a clinical examination within
their competence
• complete periodontal examination and
charting and use indices to screen and
monitor periodontal disease
• diagnose and treatment plan within their
competence
• prescribe radiographs
• take, process and interpret various film
views used in general dental practice
• plan the delivery of care for patients
• give appropriate patient advice
• provide preventive oral care to patients
and liaise with dentists over the treatment
of caries, periodontal disease and tooth
wear
• undertake supragingival and subgingival
scaling and root surface debridement
using manual and powered instruments
• use appropriate anti-microbial therapy to
manage plaque related diseases
• adjust restored surfaces in relation to
periodontal treatment
• apply topical treatments and fissure
sealants
• give patients advice on how to stop
smoking
• take intra and extra-oral photographs
• give infiltration and inferior dental block
analgesia
• place temporary dressings and re-cement
crowns with temporary cement
• place rubber dam
• take impressions
• care of implants and treatment of
peri-implant tissues
• carry out direct restorations on primary
and secondary teeth
• carry out pulpotomies on primary teeth
• extract primary teeth
• place pre-formed crowns on primary teeth
• identify anatomical features, recognise
abnormalities and interpret common
pathology
• carry out oral cancer screening
• if necessary, refer patients to other
healthcare professionals
• keep full, accurate and contemporaneous
patient records
• if working on prescription, vary the detail
but not the direction of the prescription
according to patient needs. For example
the number of surfaces to be restored or
the material to be used.
What can dental technicians do?
• review cases coming into the laboratory to decide how they should be progressed • work with the dentist or clinical dental technician on treatment planning and outline design • give appropriate patient advice • design, plan and make a range of custom-made dental devices according to a prescription • modify dental devices including dentures, orthodontic appliances, crowns and bridges according to a prescription • carry out shade taking • carry out infection prevention and control procedures to prevent physical, chemical and microbiological contamination in the laboratory • keep full and accurate laboratory records • verify and take responsibility for the quality and safety of devices leaving a laboratory • make appropriate referrals to other healthcare professionals
What can dental hygienist do?
• provide dental hygiene care to a wide
range of patients
• obtain a detailed dental history from
patients and evaluate their medical history
• carry out a clinical examination within their
competence
• complete periodontal examination and
charting and use indices to screen and
monitor periodontal disease
• diagnose and treatment plan within their
competence
• prescribe radiographs
• take, process and interpret various film
views used in general dental practice
• plan the delivery of care for patients
• give appropriate patient advice
• provide preventive oral care to patients
and liaise with dentists over the treatment
of caries, periodontal disease and tooth
wear
• undertake supragingival and subgingival
scaling and root surface debridement
using manual and powered instruments
• use appropriate anti-microbial therapy to
manage plaque related diseases
• adjust restored surfaces in relation to
periodontal treatment
• apply topical treatments and fissure
sealants
give patients advice on how to stop
smoking
• take intra and extra-oral photographs
• give infiltration and inferior dental block
analgesia
• place temporary dressings and re-cement
crowns with temporary cement
• place rubber dam
• take impressions
• care of implants and treatment of
peri-implant tissues
• identify anatomical features, recognise
abnormalities and interpret common
pathology
• carry out oral cancer screening
• if necessary, refer patients to other
healthcare professionals
• keep full, accurate and contemporaneous
patient records
• if working on prescription, vary the detail
but not the direction of the prescription
according to patient needs
What can clinical dental technicians?
• prescribe and provide complete dentures
direct to patients
• provide and fit other dental devices on
prescription from a dentist
• take detailed dental history and relevant
medical history
• perform technical and clinical procedures
related to providing removable dental
appliances
• carry out clinical examinations within their
scope of practice
• take and process radiographs and other
images related to providing removable
dental appliances
• distinguish between normal and abnormal
consequences of ageing
give appropriate patient advice
• recognise abnormal oral mucosa and
related underlying structures and refer
patients to other healthcare professionals
if necessary
• fit removable appliances
• provide sports mouth guards
• keep full, accurate and contemporaneous
patient records
• vary the detail but not the direction of a
prescription according to patient needs
What can a dentist do?
diagnose disease • prepare comprehensive treatment plans • prescribe and provide endodontic treatment on adult teeth • prescribe and provide fixed orthodontic treatment • prescribe and provide fixed and removable prostheses • carry out oral surgery • carry out periodontal surgery • extract permanent teeth • prescribe and provide crowns and bridges • provide conscious sedation • carry out treatment on patients who are under general anaesthesia • prescribe medicines as part of dental treatment • prescribe and interpret radiographs
What are the training pathway outcomes for dentists?
Clinical
Communication
Professionalism
Management and Leadership
What are the training pathway outcomes for dental therapists?
Clinical
Communication
Professionalism
Management and Leadership
What are the training pathway outcomes for dental hygienists?
Clinical
Communication
Professionalism
Management and Leadership
What are the training pathway outcomes for clinical dental technicians?
Clinical
Communication
Professionalism
Management and Leadership
What are the training pathway outcomes for dental technicians?
Clinical
Communication
Professionalism
Management and Leadership
What are the training pathway outcomes for orthodontic therapists?
Clinical
Communication
Professionalism
Management and Leadership
What are the training pathway outcomes for dental nurses?
Clinical
Communication
Professionalism
Management and Leadership
What are the CPD requirements for a dental therapist, hygienist, orthodontic therapist and clinical dental technician?
75 hours
What are the CPD requirements for a dentist?
100 hours over 5 year cycle and at least 10 hours for a 2 year period
What responsibilities does a dentist have when a complaint is made against his team?
Dentist’s responsibility to talk to the patient and to the staff member
At the end of the day, it all falls on the Dentist
What responsibilities does a dentist have when a complaint is made against his team?
Dentist’s responsibility to talk to the patient and to the staff member
At the end of the day, it all falls on the Dentist
What are the guidelines for tooth whitening?
Anything over 6% H202 is prohibited for tooth whitening or bleaching products, unless of treatment or prevention of disease
At what age does teeth whitening become legal?
Above 18 years old
What checks must be done before the treatment for teeth whitening?
Appropriate clinical exam to ensure no risk factor or oral pathology exists
Exposure to the h202 is limited and are only used for the intended use with frequency and duration considered
Products should not be available to the consumer only via a dental care professional
Explain the cycle of teeth whitening legality?
The first course must be given be a DENTIST
the following cycles can be administered by a dental care professional
Explain the cycle of teeth whitening legality?
The first course must be given be a DENTIST
the following cycles can be administered by a dental care professional
What are the botox and fillers governed by?
Medical Acts
What is the definition of a legal restoration?
That it gives the tooth a therapeutic advantage at becoming healthier, than it was in its original state in the practice
What is a risk assessment?
Weighing up the risks vs the benefits for a specific procedure
What questions should we ask to the patient when gauging patient expectations?
What they want?
What they care about?
Intermediate restorations can appease the patient’s expectations
Our own expectations need to be of sufficient standard
How to manage expectations?
Explain to the patient what modern medicine and your skills are capable of
Don’t over sell yourself
Be realistic
When a new patient arrives for a check up, and you check their teeth, what questions should you ask them?
What are the patient’s dental needs?
What are the risks?
What is the treatment?
Ask patient what their thoughts are about their dentition?
WIll the patient be happy with your treatment plan?
What problems can occur during treatment?
Don't panic Take advice Limit any damage Don't be afraid to say 'sorry' (if treatment failed/under expectations) Make the patient presentable (aesthetically) Deal with the pain first Don't be afraid to refer Prevent recurrence in the future
What actions can you implement to reduce the likeliness of patient complaints?
Careful treatment planning
Realistic expectations of treatment that patients understand
Providing questionnaires to assess what that patient thinks about the practice
Reacting promptly to patients comments giving reasons if you are not accepting them
Having a sound clinical governance programme in place
Carrying out critical incident analysis
Peer review
Making patient feel that you have their best interests uppermost in your mnd
treat patients with respect
Respect equality and diversity (equality act)
Advise patients if procedures do not go well and what you’ll do to rectify and prevent recurrence (duty of candour)
All practice staff maintain a professional demeanour
What is the definition of clinical governance?
A mechanism for monitoring and reviewing the healthcare provided for patients to give assurance that all patient receive consistent health care of an appropriate quality irrespective of where it is provided or from whom it is provided by.
To analyse the data to see if it can be used to improve the general health and healthcare of the population
How does clinical governance help the dentist?
Patient’s need to know benefits outweigh risks
Better job satisfaction
Save money from complaints or rectifying procedures
Why do we need clinical governance?
To ensure patient recieve safe treatment, effective treatment, consistent quality of treatment
What does clinical governance include?
Clinical risk management Information governance Clinical effectiveness Fitness to practice Other risks in the practice
What is included in information governance?
Data protection (GDPR 2018)
Freedom of information act
Information security
Records management
What is included in a clinical governance folder?
Contains all the protocols for each specific treatment and/or consent
To protect yourself
Consider risks and advising patient about risks
What is included when considering clinical effectiveness?
Dental materials used Effectiveness of materials Safety of dental materials Longevity of treatments Person centered care Efficiency Same treatment to each patient Timing
What is included when considering Fitness to practice?
Registered with the GDC
Have indemnity
Ensure healthy
Continue CPD
What is a proforma?
A list of steps that occur during a specific treatment
How to make a good and consistent referral letter?
Typed Copy Patient details with contact info Medical histories Dental histories History of condition Radiographs Photograph Urgency (routine, soon or urgent) Protocol if patient fails to turn up
What to include to reduce risk when thinking about treatment planning and clinical notes?
Evidence of throught and appropriate examination
Evidence of perio conditions
Radiographs as required
Study models as required
Tests as required
Explanation of risks and benefits
Necessity of the treatment for the patient
A key abbreviation to start every clinical note?
C.O.
Complaining of
if none put none
if something put something
What are the guidelines to follow for radiographs?
IR(ME)R
Unless it is an emergency what is the dentist’s ethical and legal requirement to undertake?
Must carry out a full examination and determine all the treatment necessary to secure and maintain oral health
How to increases the likeliness of a patient to attend follow up appointments?
Each appointment to be planned
What is proposed to be done at each appointment
Length of time for each appointment
Explain step-by-step to the patient what is going on
What are essential to write in the notes?
Communication with the reception staff? Does patient understand the nature of contract which they are being treated? Why patient came to the surgery? Pain? Other problems? Use templates
What other risks are there in the dental surgery?
Health and safety risk assessment Slips and trips Fire risk Electrical risk Security risk Critical incident analysis Clinical risk assessment
What to include for a critical incident analysis?
Complaints
Disasters
Things that go well
Things that do not go well
What is the definition of audit?
Identify a significant risk, do something to eliminate it, review to see if it worked
What is the definition of peer review?
Reviewing with peers processes and procedures that you follow to see what they do and see if what you are doing can be improved
What is the definition of duty of candour?
Must be open and honest with patients when something goes wrong with a patient’s treatment or care which causes, or has the potential to cause, harm or distress
Seek advice if unsure about the consequence and subsequently tell the patient something has gone wrong
Apologise to the patient and offer an appropriate remedy or support to put matter right and explain the short and long term effects of what has happened and document what has happened
Raise concerns where appropriate if you believe a patient’s best interests have been compromised
Name the 5 substandards for child protection and vulnerable adults?
Always put the patient first
Act promptly if patients or colleagues are at risk and take measure to protect them
Measure sure if you employ, manage or lead a team that you encourage and support a culture where staff can raise concerns and openly and without fear of reprisal
Measure sure if you employ, manage or lead a team that there is an effective procedure in place for raising concerns, that the procedure is readily available to all staff and that is is followed at all times
Take appropriate action if you have concerns about the possible abuse f children or vulnerable adults
