Guidelines for Clinical Patient Care Procedures

Bring to clinic

1. Clinic supplies: The Prep/dispense aide will supply students with necessary equipment prior to the appointment. Student ID with provider number bar code is required to obtain instruments, hand pieces, etc. As necessary, students should obtain disposable supplies from cluster cabinets. Use supplies sparingly. Equipment may only be checked-out for the clinic session and then returned. If equipment is not returned, the individual will be "locked-out" of the computer system and unable to obtain instruments or equipment until all previously checked-out items have been returned. Remember that Piezos must be returned with bar codes from the sterilization bag.
2. To avoid clutter, students' personal belongings such as coats, books, etc. should be stored in the student lockers on the ground floor, not in the patient treatment area.
3. Preparation of the cubicle area- Your chair is assigned in Axium on either the 2nd or 3rd floor. You must schedule the patient and enter the appointment information into Axium. The patient may call the desk for confirmation.

Chair video tutorial for Baltimore

http://mediasite.umaryland.edu/mediasite/Viewer/?peid=9c50238562294e94b4266c90375a2e75

1. Check operation of all dental unit parts. If the unit is inoperable or defective, contact call or email chair maintenance (e-Mail: dstechservices@umaryland.edu or call 6-7137 with chair # and description of the problem.
2. Cubicles that are littered with materials from other clinicians should be reported to the GP Manager
3. Prepare cubicle using appropriate disinfection and barrier techniques
4. Fill in preliminary data on patient/client paperwork and inform your faculty of anticipated services for the day.

Admitting the patient

1. Greet the patient/client by name in the reception area, introduce yourself and escort the patient/client to your cubicle.
2. Patient's personal belongings must be placed on a hook in the cubicle. Ladies' purses should be kept with them at all times.
3. If patient is not in the assigned reception area:
   1. Check other reception areas
   2. Call patient after 15 minutes to see if they are on their way.
4. Allow patient 1/2 hour for arrival. Consult with instructor about use of clinic times.
5. All patients must sign-in with the GP receptionist when they arrive. This applies even if you are there to greet them.

If patient fails to keep appointment, enter date and relevant notation in the contact notes of the patients Axium electronic patient record.

Document failures, cancellations through Axium

Checking-out and dismissing patient

1. When treatment is complete, the instructor must be notified before dismissing patient. The patient must be examined by the instructor during the appointment and before dismissal for the day.
2. If possible, arrange the next appointment with the patient before the patient leaves the Dental School.
3. Note the patient's disposition in the progress notes. The treatment provided and the treatment planned for the next appointment should also be in the progress notes entry.
4. Be sure to return all belongings to the patient including full or partial dentures.
5. Escort the patient to the reception desk.
6. Dental Hygiene patients must be dismissed no later than 11:30 a.m. for morning clinic or 3:30 p.m. for afternoon clinic to allow adequate time for chart documentation, paperwork, and review of clinical progress with instructor. Charts must be swiped prior to leaving clinic.

Record Maintenance

1. Enter all services rendered in the Progress Notes in the EPR. All patient records are to be completed and swiped by instructor prior to leaving clinic. When using any dental material such as sealants, the chart entry should include the tooth surfaces, the generic material followed by the specific name of the product. Cancelled and broken appointments should also be entered in the progress notes and in all cases both the student and the instructor must sign/swipe the entry.
2. Entries that do not have all information completed properly will not be swiped and will be returned to the student for completion.
3. Instructors must swipe all evaluation forms and chart entries. Students are responsible for obtaining all required swipes. Only the faculty that supervised you that session can swipe.
4. At the completion of the appointment, all department clinic forms (e.g., blue forms) should be placed in the Clinic Notebook until the next appointment or for review by the SAS Advisor.
5. The final entry in the progress notes should reflect the next activity planned or departmental assignment for the patient.

Policy for Local Anesthesia

Dental hygiene students administering local anesthesia

Student should present all relevant information to faculty, which must include:

1. Reason for anesthesia i.e. Analgesic, Patient comfort, vasoconstriction, etc.
2. Suggestions for anesthetic agent to be used and rationale.
3. Injection sites planned and duration of procedure.
4. Any medical or psychological interactions or concerns.

If use of anesthetic agent is approved, be sure to follow all safety procedures while delivering the anesthetic. Have all supplies needed on a tray or table covered with paper towel. Document in progress notes all procedures and amount used in mgs. The GP Director should be informed that local anesthesia is being delivered. The student should obtain the needed materials from the Prep/Dispense depending on the procedures needed. The dental hygiene student in conjunction with his/her instructor will decide on the appropriate anesthetic drug to use for the particular procedure and provide rationale. The dental hygiene student must alert the dental hygiene faculty of significant medical history and vital signs. This applies to hygiene students not yet trained in Local Anesthesia. Seniors that are trained will administer their own anesthetic with dental hygiene faculty approval. Seniors can ask for assistance and observance as they wish.

Policy for local anesthesia in dental hygiene when you are not giving the anesthetic

After conferring with a dental hygiene instructor, the dental hygiene student arranges for a Dental Hygiene Faculty who is certified to administer anesthesia if the student has not yet been educated on LA.

Removable partial Denture/Denture cleaning

1. Wearing your PPE, place the appliance in a headrest cover, which has been labeled with the patient’s name.
2. Take the appliance to the “dry lab” (one on each floor). Cover the appliance with cleaner (tartar and stain remover – which has been properly diluted.
3. Place the headrest cover inside a red bag (in case of puncture). Place the red bag inside the ultrasonic unit (which has been filled with water), using the lid to secure the bag.
4. Run the ultrasonic for 10-15 minutes (see manufacturer’s instructions on bottle).
5. Remove the appliance from the bags and discard the tartar/stain remover solution. Rinse the appliance thoroughly for at least one minute, under room temperature, running water; PRIOR to returning the appliance to the patient.
6. A denture brush can be utilized to remove soft debris from the appliance.

NOTE: failure to thoroughly rinse the appliance will result in a burning sensation or bad taste to the patient. If this occurs, have the patient rinse with clear water for 60 seconds, and inform your faculty. Be sure to document this in the patient record.

Telephone Messages

Telephone messages to students will be received by the GP receptionist. Clinic calls to faculty will be forwarded to the respective department. Patients may leave an appointment message after hours by calling 410-706-7104. Patients who are not local may call 800-332-8622, mailbox number 6-3832 to leave a message.

You may also choose to have patient’s contact you directly using your cell phone number. Remember that service may be unpredictable in the building and you cannot always rely on a signal.

Student-Patient Relations

1. Students must be prompt for patient appointments. Patient cancellations and failures must be recorded in the patient’s contact notes. Excessive failures, cancellations or persistent tardiness, documented in the EPR, may justify patient dismissal. The PCC must be consulted prior to discontinuation of patient treatment.
2. Every patient must check out with the receptionist after each visit, regardless of whether there was a fee associated with the appointment. A walkout receipt must be provided to each patient at each visit.
3. All patient related conflicts and adverse incidents must be recorded in the progress notes of the patient record, signed by the student and swiped by faculty. In addition, a Special Incident Report may be required. Please see the PCC for assistance.
4. Visitors, family and friends of patients are not permitted in the treatment area without permission from the supervising instructor.
5. Before treating a severely apprehensive or argumentative patient, consult with your supervising instructor or a GP Director.
6. If a student is uncertain or has difficulty completing a procedure, the supervising instructor should be consulted immediately. Unexpected outcomes in treatment must be recorded in the patient record and the patient must be fully informed.

Guidelines for Faculty Intervention for Patient Treatment

Department of Dental Hygiene faculty and students adhere to the following guidelines to determine when faculty should intervene and provide patient treatment:

• When a student needs to complete patient in a given appointment and cannot finish by the end of the clinical session, faculty may complete the treatment services. This will be done in special circumstances, such as:
  • Patient has been in for more than the usual number of appointments required for a defined difficulty level;
  • Patient is pre-medicated and/or of anti-coagulant therapy, and could be completed in that appointment with faculty intervention;
  • Other extenuating circumstances that would make it difficult or impossible for the patient to return for another appointment to complete treatment.
• When the scaling and root planning are extremely difficult due to heavy deposits and/or complicating oral or systemic factors, faculty may complete selected areas of the mouth. This is done only when required to keep the number of appointments to a reasonable level and when the student has had sufficient experience with the patient to ensure development of instrumentation skills with heavy deposit.

D.D.S. Exams Guidelines

(Periodic oral exam / or investigation of a concern)

The covering Dentist will expect the following steps to be completed before a dental faculty member will perform a periodic oral exam or a limited problem focused oral exam:

1. Review medical history with the patient
   1. Update any changes in medications
      1. Document this in the patient EPR with the date followed by the medications and dosages
   2. If patient can’t remember a new medication/dosage, document this as well.
   3. If there are any changes in medical history, update the medical history form in the EPR.
2. Review radiographs
   1. Check the date of the last full series
   2. Check the date of the last Panoramic
   3. Check the date of the last bitewings
      1. For the guidelines on when to update radiographs, see Radiology Guidelines.
   4. Update radiographs as necessary
3. Perform your clinical exam
   1. Summarize your findings for the dentist
      1. Periodontal concerns
         1. Pockets 4+mm
         2. Significant mobility
      2. Caries
      3. Anything of note that you feel needs to be evaluated by the dentist.

If the patient has a chief complaint and they are not due for their DDS exam this visit, then you still need to go through the same steps 1-3. In addition to those you should also ask the following questions:

1. History of Present Illness
   1. How long has the patient had this problem?

When you present the patient to the dentist for the exam use the following format:

• Introduce the patient to the faculty member.
• Mr. /Ms. X presents today for a recall exam.
• Student discreetly presents medical history to faculty. (Allow the faculty to read the medical history). Remember to be as private as possible.
• Blood pressure today is.
• Relay the chief complaint, if there is one, or concern.
• Present the radiographs. Note any radiographic findings that are new and pertinent.
• Review your clinical findings at this time.