Dental Hygiene Program

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Clinical Evaluation - Critical Errors Document

It is the intent of the dental hygiene faculty to facilitate an educational environment wherein each student develops professional and ethical standards and attains clinical competency that prepares them to enter the dental hygiene profession.

The criteria on this Clinical Evaluation Document is a GUIDE for students and faculty to be aware of specific skills that are expected of the students during patient treatment. They are NOT meant to be considered exactly as they are written when determining student grades. Increasingly, with each subsequent clinical semester, the student is expected to progress and develop more independent critical thinking and decision-making skills while practicing under the direct supervision of licensed dental and dental hygiene professionals. As students move through the curriculum, they are expected to be more skilled in each of the listed categories. It is expected that students continue to consult and seek guidance from licensed faculty at required intervals during appointments and upon each progressive semester, demonstrate the ability to think and follow through with Clinical care with increasingly less dependence on faculty guidance.

Critical errors are any demonstrated student behaviors deemed unprofessional, unethical, and/or incompetent clinical care. Violation of stated rules, regulations or policies of the University of Maryland Dental Hygiene Program and the Dental School will result in a report made by the faculty member who observed the error to the SAS advisor, clinic coordinator, Director, and the Dean of Student and Academic Affairs.

Professionalism

The student will develop a level of professional conduct, demeanor, and organization that demonstrates a commitment to quality care for all patients. Students will exhibit professional and ethical behavior with patients/clients, faculty and peers in all clinical and simulated clinical experiences.

Observable behaviors

The student will:

  1. Comply with the policies and procedures defined in the Dental Hygiene Clinic Handbook.
    • Obtain appropriate faculty signatures
    • Make appropriate entries in progress notes using ATEN format (including treatment, specific health strategies, referrals and recall interval)
    • Obtain patient or parent/guardian consent prior to treatment (except co-therapy patients)
  2. Present a professional appearance and demeanor.
    • Demonstrate respectful attitude and rapport with patients, other health professionals and members of the dental school community including: faculty, students and staff
    • Adhere to clinic dress code
    • Demonstrate effective verbal and non-verbal communication
    • Seldom leave patient or interrupt appointment
    • Ask for faculty intervention or help when appropriate
    • Alter existing treatment plan in a timely manner according to patient needs
  3. Employ appropriate infection control measures.
    • Maintain a hygienic and safe operatory
    • Provide patient with safety glasses
    • Provide patient with pre-procedural mouth rinse (30 second duration) prior to aerosol producing procedures
    • Follow Personal Protective Equipment protocol (mask, eyewear, gloves)
    • Follow clinical protocol for handling sharps
    • Follow other infection control procedures
    • Follow end of the day clean up procedures thoroughly
  4. Utilize all available clinic time appropriately (TIME MANAGEMENT).
    • Complete chart entries accurately, thoroughly and in a timely manner
    • Utilize “down time” effectively and efficiently (e.g., waiting for anesthesia, waiting for faculty evaluation)
    • Obtain or set up appropriate equipment and supplies for anticipated procedures
    • Be prepared and ready to start clinical sessions promptly at the beginning of each clinic session such as 9 a.m. and 1 p.m.
    • Use time appropriately during any phase of treatment
    • Review protocol for clinical procedure and anticipated treatment (e.g., cleaning dentures, use of ultrasonic)
  5. Work in balance for all intra-oral procedures.
  6. Present data to faculty in a clear, scientific, concise and organized manner.
    • Review patient chart prior to appointment
    • Display most recent/appropriate radiographs
    • Disclose confidential information appropriately
    • Address patient’s “chief complaint” early in an appointment
    • Address patient’s needs for pain control (e.g., topical anesthesia, local anesthesia, dentin desensitization)
    • Be familiar with comprehensive treatment plan

*Critical errors: automatic failure for errors this category. Items listed as quantitative errors are counted individually.

Health History

The student will obtain, document, and utilize an accurate and comprehensive health history in providing patient/client care.

Observable behaviors

The student will:

  1. Review health history prior to patient appointment.
  2. Perform health history assessment with patient or appropriate guardian (as in the case of a minor and persons not reasonably/legally able to provide complete or accurate history).
    • Follow up, document, and report all “positive” patient responses to heath history questions
    • Competently perform health history assessment (Ask open ended health history questions that elicit complete patient responses; use appropriate terminology to best elicit patient responses and explanations of medical history from patients
    • Assess patient compliance with pre-medication and other prescribed medical treatments
    • Determine patient’s chief complaint
    • Compares and reports patient’s current medical history and chief complaints with past history
  3. Summarize relevant medical and dental patient conditions (present and past), medications, and document in record and present to faculty at every patient appointment before proceeding with any clinical assessment or treatment.
    • Promptly report and appropriately documents patient’s chief complaint to faculty
    • Alert faculty to any medical or dental condition that warrants immediate intervention or poses a risk to patient and/or clinicians
    • Appropriately determines need to modify treatment based on medical and or dental history
      • Identifies the need for prophylactic antibiotic coverage,
      • Identifies the need for medical consultation or any additional information, consults, referrals or precautions
      • Documents consultations
      • Facilitates and appropriately follows up on consultations in a timely manner
    • Compares and reports patient’s current medical history with past history
  4. Investigate all medications as to: indication, dosage, regimen, contraindications, dental considerations, and mode of action.
    • Look up patient medications prior to appointment for known medications; prior to health history check-in find out any new meds
    • Report with drug cards at health history check-in with faculty before proceeding with any clinical assessment or patient treatment
    • Compares patient’s current medical regimens including medications to past medication and treatment regimens
  5. Measure, report and document vital signs at every appointment before proceeding with any clinical assessment or patient treatment.
    • Accurately and completely measure, report, and document blood pressure, pulse, and respirations throughout the appointment as needed
    • Consult with faculty when vital signs are inappropriately high or low and/or poses concern to safely treating patient
    • Follow up with patient and physician for any vital signs warranting further evaluation/re-assessment, medical consultation, or immediate referral
      • Facilitates consultation
      • Documents consultation and follows up with consultation in a timely manner
    • Report vital signs to any clinician rendering clinical services, exams and treatment to patient throughout patient appointment
    • Compares and reports patient’s current vital signs with past history of vital signs

*Critical errors: automatic failure for errors this category. Items listed as quantitative errors are counted individually.

Sample Drug Card

Drug Name: Aspirin

US. Brand Names: Ascriptin, Aspercin, Aspergum, Bayer, Bufferin, Ecotrin, Sureprin, Halfprin

Classification: Antiplatelet Agent; Salicylate

Type of Medication: Oral

Action/Use: Treatment of mild to moderate pain, inflammation and fever, maybe used as prophylaxis of myocardial infarction, infarction of stroke, and/or transient ischemic episodes, management of rheumatic fever, rheumatoid arthritis, Osteoarthritis and gout.

Mechanism of Action: Irreversibly inhibits cyclooxygenase-1 and 2 (COX-1 and 2) enzymes, via acetylation, which results in decreased formation of prostaglandin precursors; irreversibly inhibits formation of prostaglandin derivative, thromboxane A2, via acetylation of platelet cyclooxygenase, thus inhibiting platelet aggregation; has antipyretic, analgesic, and anti-inflammatory properties.

Drug Interaction: Avoid ethanol or> 3 drinks/day- can increase bleeding risk.

Oral or Other Side Effects: Caution in patients with platelet and bleeding disorders, renal dysfunction, dehydration, erosive gastritis or peptic ulcer. Do NOT discontinue use prior to dental surgery.

Effects on Dental Treatment: Bleeding is associated with aspirin, hemorrhage may occur at virtually any site. Risks depends on dosage, and concurrent use of multiple agents and patient susceptibility. At low dosage, adverse effects rare.