OSCE style Flashcards
Breaking bad news to a patient
-adjust to the same level as them, be attentive
-would you like someone with you?
-do you know why you’re here today?
-What do you understand so far?
-Don’t use jargon
-Don’t lie or downplay
-Is it okay if I share the results with you now?
-I wish I had better news
-I’m really sorry to have to tell you this
-share small bits at a time
-include periods of silence
-confirm they understand as you go through with them
-I can really empathise with your situation
-empathy ‘to put yourself in someone else’s shoes and have an appreciation for their feelings’ - adjusting yourself to accommodate them
-I can see you’re really upset by this news
At the end, summarise the news, allow them to ask questions, give a plan of what’ll happen next, give written material if they’d like it, reassurance for the patient (that you’ll be here to support them)
Breaking the chain of infection
Avoid damp conditions
Use fresh detergent/disinfectant
Frequently change ultrasonic bath
Use purified water for steriliser reservoir and change frequently
Single Use (sterile) instruments where possible
Hand hygiene
Type B steriliser
Aseptic technique
Managing expectations
Be CLEAR:
Connect - build rapport
Listen - to their wishes
Empathise - to their situation
Ask - their expectations
Review - their wishes accurately
Confirm - what can be done
Commenting on a previous dentist
DON’T DO IT!
You don’t have access to the clinical information at the time or their records, so avoid passing judgement under all circumstances
“All I can do is offer treatment based on what I can see now”
Avoiding complaints
Professionalism
Managing expectations
Empathy and compassion
Effective communication
6 core principles of taking on a complaint
All your feedback is important to us
We want to make it easy to raise a complaint if you need to
We follow a complaints procedure and keep you informed
We will try to answer all your questions and any concerns you raise
We want you to have a positive experience filing a complaint
Your feedback helps us improve our service
If a complaint is justified, offer a fair solution.
NHS Scotland complaints Handling Procedure
Stage 1 - local level (early resolution) “on the spot” within 5 working days
Stage 2 - (investigation) Acknowledge within 3 days, completed in 20 working days
Patients given details of PASS and Scottish Public Services Ombudsman
In Scotland, the NHS complaints handling procedure aims for local resolution first, with two stages: Stage 1 focuses on resolving issues directly with the healthcare provider, and Stage 2 allows complaints to be escalated to the Scottish Public Services Ombudsman if not resolved locally
Take advice from indemnity insurer
Try to settle the complaint internally where possible
If resolved externally, comply with expectations of regulator
Signs of complaint from the patient that cannot verbally communicate
Sleep interruption
Changes in behaviour
Rubbing of an area
Pulling at an area
Does this patient have capacity?
Do they understand what the proposed treatment is, why it would be necessary, its purpose
Do they understand the risk and benefits of the treatment
Do they understand their alternatives
Do they understand the consequences if nothing is done
Do they have the capacity to remember their decision
Treatment for a patient with incapacity
It must benefit the patient
It must be the least restrictive option
It must take into account the wishes of the person
It must be in consultation with relevant others
It must encourage the person to use existing capacity
Augmentative talking aids
Social story
Action cards
Picture boards
Talking boards
Talking mats
Draw/write
Photos
Ipad
Give denture hygiene advice
-Take dentures out at night and soak in plain water
-Clean with soft toothbrush and denture cream or soap and water morning and night
-Rinse dentures after every meal
-Clean over the sink filled with water in case of dropping
-Clean with disinfectant solution at least 20 minutes once a day
Remember to clean your existing teeth and gums too
Patients suitable for GA and patients not suitable for GA
Consider:
•The co-operative ability of the child.
• The perceived anxiety and how the child has responded to similar procedures.
• The degree of surgical trauma anticipated.
• The complexity of the operative procedure.
• The medical status of the child.
Indications:
Severe pulpitis requiring immediate relief.
• Acute soft tissue swelling requiring removal of the infected tooth/teeth.
• Surgical drainage of an acute infected swelling.
• Single or multiple extractions in a young child unsuitable for conscious sedation.
• Symptomatic teeth in more than one quadrant.
• Moderately traumatic or complex extractions e.g. ankylosed or infra-occluded primary
molars, extraction of broken-down permanent molars.
• Teeth requiring surgical removal or exposure.
• Biopsy of a hard or soft tissue lesion.
• Debridement and suturing of orofacial wounds.
• Established allergy to local anaesthesia.
• Post operative haemorrhage requiring packing and suturing.
• Examination under GA, including radiographs, for a special needs child where clinical
evidence exists that there is a dental problem which warrants treatment under GA.
Severe pulpitis and acute infection are by far the most common conditions treated under GA
• Carious, asymptomatic teeth with no clinical or radiographic signs of sepsis.
• Orthodontic extraction of sound permanent premolar teeth in a healthy child.
• Patient/carer preference, except where other techniques have already been tried.
Extenuating circumstances that override the above limitations are:
• Physical, emotional, learning impairment or a combination of two or more of these.
• Children who have attempted treatment using LA alone or LA combined with conscious
sedation and been unable to co-operate.
• Medical problems which are better controlled with the use of GA.
Please read your GA screenshots folder.
GA outcome
Dentally fit/ asymptomatic dentition for next 2-3yrs at least to avoid recurrent GA
GA risks
Death 1:200,000 approx: risk higher with higher risk cases
Nausea
Vomiting
Lethargy
Confusion
Delayed recovery
Dizziness
Bruising
Sore throat
Allergic reaction to anaesthetic
IH sedation
Requires enough cooperation to breathe in and out of nose and keep mouth open
IV sedation
Useful for patients with involuntary movements- Huntingtons, cerebral palsy
What do you do:
Uncooperative child and;
Reversible pulpitis
Irreversible pulpitis
Periapical infection
RP - try temporise the tooth (if not able, analgesics)
IP - try to place a sedative dressing (if not able, do not give AB - does not help pain/pulpal inflammation)
PI - antibiotics and plan for GA/sedation
Where do you refer mod/severe Intellectual impairment/disability cases
Special care Dentistry
They can tx plan and refer appropriately for GA/sedation ect.
