PMHP Flashcards
domestic abuse AVDR
ASK
- about abuse in private setting without family members
- use non judgemental language
- is everything okay at home
- do you feel safe
- i’m worried that you don’t feel like you’re usual self
VALIDATE
- provide validating messages that take blame away from victim
- show pt you are concerned for them
- you don’t deserve to be hit no matter what happened
- concerned about your safety
- should still do this even if pt denies abuse as it may provide some comfort / relief
- helps victim start to realise seriousness of their situation
DOCUMENT
- be specific
- use pt own words
- name, location, witnesses that the pt mentioned
- describe injuries in as much detail as possible take photographs if allowed
REFER
- to appropriate services
- even if they don’t seem keen still offer as they may go away & think about it
- do not attempt to deal with problem yourself
- scottish domestic abuse helpline
introduce self, use domestic abuse pamphlet, use ‘secret’ lip balm or pen
statistics - new MW vc leading brand MW. null hypothesis, 95% confidence, risk ratio of 1.39
ARR - difference in risk between groups
RR - ratio of the risk in each group
NNT - no needed to tx to prevent x1 pt from developing the risk
95% CI - 95 / 100 times the CI will contain the true value in the entire population; can be determined for both ARR & RR
null hypothesis is true or rejected = intervention works only as well as the control
for ARR - if the confidence interval range overlaps 0 = null hypothesis i.e. risk reduction with the intervention was 0 then the intervention is the same as the control
for RR - if CI range over laps 1 = null hypothesis i.e. if the ratio with of intervention risk over control risk was 1 then the intervention & control risk are the same
can also comment on broadness of CI range - a narrow range means study is more representative of true population results
what type of study:
RCT - prospective
cohort study - prospective
case control - retrospective
cross sectional study - one single point of time
criteria for good RCT = blinding / inclusion & exclusion criteria / randomisation / control / all subjects accounted for at the end
handling complaints - pt complaining re colleague & crown fallen out after a week
take concerns seriously & answer questions as able
acknowledge anger ‘ i can see that you’re upset & i’m sorry that you feel that way’ this is not accepting blame
try to offer practical help
- offer to take tx over colleague
- offer investigation with colleague & provide feedback for pt
- would you like me to recement crown
- what would you like to do and we can work with you
making an apology - be honest, acknowledge the offence, explain how it happened, ensure amends; is there anything we can do
if formal complaint requested advise on NHS complaints procedure then if required a local resolution (payout), if satisfactory complaint closed and if unsatisfactory healthcare commission or health service ombudsman
NHS complaints procedure -
acknowledge complain & provide pt with practice complaint procedure / inform dental defence organisation if you require advice / inform pt of timescales & stages involved / acknowledge complaint in writing by email or telephone as soon as you receive it 3 working days max ideally within 24hrs / early resolution 5 working days for issues that are straightforward & easily resolved requiring little to no investigation
investigation 20 working days for issues which have no been resolved at early resolution stage or those that are complex / serious / high risk
independent external review ombudsman for issues that have not been resolved
breaking bad news, unrestorable 11 requiring XLA - SPIKES
S - setting
sitting down at same level as them / try to make as comfortable as possible
P - perceptions
what does pt understand has happened until now & what is pt expecting from appt
I - information
inform pt you would like to discuss prognosis of tooth & ask them if they would like to discuss that
K - knowledge
give warning shot - i’m afraid it’s not great news & then give knowledge that you know i.e. unrestorable and requires XLA. let that sink in & let them dictate pace of conversation from here & give them the chance to ask qs
E - empathy
understand this is hard for you / not what you wanted to hear
S - summary & close
repeat the news, summarise what you’ve told them & plan for going forwards
aim to restore asap
immediate - immediate denture in short term & XLA, bridge using own sectioned crown if available, direct polycarbonate crown bridge
permanent - bridge, denture, implant after 3mths following bone stabilisation
do not mention unrealistic interventions
ask if any qs, ensure pt has clear plan of what will happen next, offer them a follow up appt or phone for any qs
smoking cessation
ASK - do you smoke / what do you smoke / how long for / how many cigarettes daily / how quickly do you light up in the morning / does anyone in family smoke / do you have children in the house
ADVISE - smoking harmful to general health due to cardiovascular & respiratory problems / detrimental to oral health; risk of tooth loss, reduced ability to heal, periodontal dx, oral cancer / personal reasons - bad breath / financial
ASSESS (motivation to quit) - are you interested in giving up / have you tried to quit in past / if unsuccessful why so / what worked in the past
ASSIST - would you like help from local stop smoking services / increases quitting likelihood x4 / best & evidenced tx = nicotine replacement therapy; champix / patches / gum / ecigs
note on ecigs = new to market don’t full know side effects / respiratory side effects such as fluid in lungs / likely less harmful than tobacco / don’t vape around children / no long term health data / maintains habit & culture of smoking
REFER - those interested to pharmacy / GP / stop smoking services i.e. quit your way / offer written material / arrange follow up
nurse sharps injury from LA needle - BBV risk assessment
explain nature of injury sustained by dental nurse to pt - note risks are to nurse & not to pt
explain risks of BBV to nurse - risk of transmission of a BBV inc HIV to nurse & estimate of risk i.e. 1:300 HIV so relatively low
explain standard procedure for managing sharps injuries which is applied to all pts, explanation of requirement for blood sample & clarify universal process applied to all patients -approach sensitively & professionally but pt has right to refuse
undertake rv of MH inc - ever been dx with hep b / c / hiv, ever injected drugs or had sex with someone who has / ever had sex with another man / sex with someone from a country outside of UK, western europe, canada, usa, oz or NZ / ever had a blood transfusion not in one of the above countries / ever had dental tx in a country not listed / from a country not above / tattoo or piercing done by unlicensed artist in UK or outside UK / yes to any of above indicates high risk
consent - establishes pt understands options, gives opportunities to ask questions, confirm pt decision to give bloods is yes or no
