Special care: people with disabilities Flashcards
“Special Care” for (1)
a physical, sensory, intellectual, mental, medical, emotional or social impairment or disability or, more often, a combination of a number of these factors.
Patients are people! (5)
Patients with a disability do not have a decreased need or entitlement to quality, sensitively delivered dental care
All dental professionals have an obligation to ensure their patients have the best possible care
Human Rights Act 1998
Disability Discrimination Act (DDA) 2005
Holistic approach to dentistry
Delivery of Special Care Dentistry (3)
Salaried Primary Dental Care Services
Hospital Services
General Dental Services
Salaried Primary Dental Care Services (2)
Community Based Specialist Practitioners -consultants -specialists -senior Community Dentists -community Dentists -DCT2
Case Mix (6)
Divided into 6 domains 4 categories to each domain 0 A, B, C Each category carries a weighting Total weighting and Complexity Grade
Case Weight 35: Grade 5
Case Mix domains (6)
Communication Co-operation Medical status Oral RIsk Factors Access Legal and ethical barriers
Case Mix: Communication (3)
A: Mild restriction
B: Moderate restriction
C: Severe restriction
Case mix: community - mild restriction (4)
Some difficulty in communication but can overcome with or without use of aids. In most situations patient can communicate for themselves without intervention of 3rd party.
Patient speaks English but not as first language.
Patient has mild learning difficulty.
Patient has hearing impairment e.g. Lip reads
Case mix: community - moderate restriction (6)
Patient does not speak English and requires services of interpreter to communicate.
Limited communication possible. Problems with communication not able to be completely overcome.
Patient requires communication in writing; using sign language/Makaton or other communication aids.
Patient communication requires carer as interpreter.
Patient has moderate learning difficulty.
Patient has mild dementia
Case mix: community - severe restriction (5)
No ability to communicate. All discussions regarding treatment conducted through a 3rd party.
Patient has profound learning disability.
Patient has advanced dementia.
Patient with advanced Huntingdon’s disease.
Patient with severely debilitating brain injury.
Overcoming the communication barriers (a lot)
Facilitating lip reading
Sound loops
Interpreters - Sheffield Community Access & Interpreting Service SCAIS
Carers/relatives – experienced in communicating with patient
Sign Language
Speech boards
Pen & paper
Use of appropriate language
Pictures for patients
Living Wills
Independent Mental Capacity Act Advocates IMCA’s
Case Mix - co-operation (3)
A: Some Difficulty
B: Considerable Difficulty
C: Severe Difficulty
Case Mix - co-operation - some difficulty (4)
Able to complete examination but not all other procedures required in episode of care.
Treatment completed with a limited amount of interruption.
Patient requires up to 50% longer appointment length to complete treatment (in comparison to code 0).
Patient requires up to 2 behaviour modification/acclimatisation visits before treatment commences.
Case Mix - co-operation - considerable difficulty (6)
Limited examination only possible.
Formal risk assessment relating to any physical intervention that maybe required.
Considerable interruption disrupts provision of treatment.
Additional precautions required because of violent or inappropriate behaviour.
Patient requires more than 50% longer appointment length to complete treatment (in comparison to code 0).
Patient requires 3 or more behaviour modification/acclimatisation visits.
Case Mix - co-operation - severe difficulty (3)
Unable to examine without a GA
Sedation or GA required for treatment
Patient requires 5 or more behavioural modification/acclimatisation visits prior to treatment
Co-operation - overcoming the barriers (a lot)
TLC Acclimatisation Tell-show-do Shorter appointments More appointments Behavioural Modification – CBT Acupuncture Hypnosis Inhalation sedation Intravenous sedation Oral Sedation General Anaesthetic Restraint
Aromatherapy (4)
Lavender
Bergamot
Chamomile
Sandalwood
Acupuncture (4)
Governor Vessel meridian -GV 20 (top of head) Large Intestine meridian -LI 4 (hand) Extra Points -EX 6 (top of head) Conception Vessel meridian -CV 24 (chin)
Define restraint (2)
‘The positive application of force with the intention of overpowering the person’, which, by definition, is without that person’s consent.
Define holding still as immobilisation (2)
may be used to help a person cope with a painful procedure effectively and is carried out with the person’s consent. It differs from restraint in the intention and degree of force required.
Define ‘containing’ a person (2)
physical restraint or a barrier aimed at preventing the person from harming themselves or others.
Ways of restraining (3)
Physical Intervention - PI -handholding -cradling/Supporting -clinical Holding -papoose Boards etc Chemical Restraint General Anaesthesia
Physical intervention - handholding (4)
Dental nurse/ carer/ parent
Always with consent of patient or parent of child
Always with agreement of parent of older person or carer of patients who cannot consent for themselves
Document
Physical intervention - cradling and supporting (5)
Explanation of why Consent/Agreement Document Dental nurse/ parent/ carer Wheelchair
Physical intervention - papoose boards - when are they used (2)
Parkinson’s
Huntingdon’s
Cerebral Palsy
Any condition where there may be uncontrolled and/or sudden movements
Contraindications to physical interventions (4)
History of cardiac disease
Existing breathing difficulties
Osteo-pathology
Down’s Syndrome with atlanto-axial joint instability
Case mix - medical status (3)
Treatment modification required
Moderate impact of medical or psychological condition on provision of care
Severe impact of medical condition on provision of care
Case mix - medical status - treatment modification (a lot)
Medical history obtained but some slight modifications to patient management Antibiotic cover required Stable Epilepsy Mental Health -drug Interactions -xerostomia Rheumatoid Disease Sjogren’s MRSA on domiciliary basis – clinical area Substance Misusers -DVT -liver damage required.
Medical status - moderate impact (4)
Complex medical condition severely affects the ability to treat and choice of treatment.
Tests and special arrangements are necessary.
Medical or psychiatric history not able to be obtained without additional investigations and enquiring with other health and social care workers.
Medical status unstable affecting provision of dental treatment.
Medical status - severe impact
Complex medical history requiring multidisciplinary review in order to decide whether or not to treat and precautions required, eg case conferences, joint review with anaesthetists
- blood Disorders
- brain/Spinal Injury who are bedbound
