TRIAGING
Please find the current procedures on triaging
Due to the current crisis remote working is being implemented nationally in all fields and aspects of life.
As instructed by the CDO based on risk assessment and triage outcomes, wherever possible patients' urgent dental care needs should be managed remotely through the provision of advice, analgesia and antimicrobial means where appropriate.
This can be done remotely or at the practice. The Scottish Dental Clinical Effectiveness Programme (SDCEP) has developed guidance around triage for acute dental problems during the COVID-19 pandemic found here
Each patient should be assessed and managed on their own merit, taking into account the patient’s best interests, professional judgement, local arrangements and the prioritisation of the most urgent care needs.
1. Patient risk assessment should be conducted remotely (eg telephone, video link) to determine the patients risk category
- Are signs/ symptoms/ history suggesting patient is suspected infected
- Are they deemed at risk category/ vulnerable
2. Is the patient in Urgent Need please see service details here for a definition of what is urgent need or use SDCEP toolkit here
- If the patient has a need for routine non-urgent care (including orthodontics), which should be deferred if urgent dental care needs can be managed remotely (eg patient requires advice only)
- If the patient is deemed emergency they should be immediately instructed to attend A&E/ Ambulance called
If the patient is deemed in urgent dental need then they should be managed in the first instance using AAA [see below]
3. If the patient cannot be managed remotely, whether management can be delayed; if it cannot be delayed, referral to the appropriate face to face treatment service to the most appropriate place and time for the patient to be seen (in line with patient group and care requirements).
With limited resources and slots available, prioritisation must be made of patients with the most urgent needs.
You must use your own professional judgement to see or not to see the patient face to face. The justification and factors considered needs to be recorded. A non-exhaustive list of factors that should be considered in no particular order will be:
- Have previous measures not managed the situation? (for example, advice/analgesics/antibiotics if indicated)
- Is the patient COVID-19 positive/COVID-19 negative/asymptomatic/in known recovery from COVID-19 /in self-isolation/in a high risk group?
- Your own health status
- Capacity and availability of appropriate PPE (see PPE)
- What procedure would be planned
- Whether the planned procedure requires an aerosol generating procedure Using your professional judgment and what’s in everyone’s best interest, to do a face-to-face assessment/treatment
- If your management is in line with what your indemnity provider supports
- The patient’s views/wishes having discussed the risk factors above
- The patient’s best interest
- The patient’s consent (following the Mental Capacity Act for those people who lack capacity)
- The welfare of practice staff.
Record keeping
Good contemporaneous clinical record keeping should be kept for remote patient consultation. This allows the dentist to be in full possession of the issues that will impact on the clinical risk assessment. Patient records should be easily identified and retrieved for evaluation purposes.
Clinical details of the complaint and advice given along with any medication prescribed and discussion about review or onward referral.
HISTORY TAKING:
A) Medical history- Taking a full medical history is very important as you will be unlikely to a get a signature from the patient.
B) Existing co-morbidities identified by the government that place a patient at risk:
C) Ongoing treatment, recently completed or planned treatment
D) History of current problem
E) Social history.
You are required to complete a database set as according to your site and service manager this may be in a spreadsheet or compass data please refer to your service manager
QUESTIONS ON COVID-19 ARE ESSENTIAL AND WILL FORM BASIS FOR ANY REFERRALS
As part of risk assessment, the following questions should be included, in line with the case definition for possible COVID-19 and isolation requirements:
– Do you have a new, continuous cough?
– Do you have a high temperature (37.8C or over)?
– Does anyone in your household have a new, continuous cough or a high temperature?
– Have you had a sudden loss to your sense of taste or smell?
– If you or anyone in your household has tested positive for coronavirus, are you still in the self/household isolation period?
iSmile help: portal:
Google remote desktop/ Team viewer
- Bigwords account
- East Anglia service
- Google translate
Guides, Resources and Applications for Remote Dental Consultations
Video consultation applications
These should provide equivalent (or better) facilities for remote consultation than standard telephone. They will be similar in terms of GDPR to a regular telephone, provided that you do not record the call or retain images. If you wish patients to send you images on a platform that is not GDPR, you should make the patient aware of this before they agree to use it.
It is important to explain to the patient in advance that
• the consultation will not be recorded,
• this is being used is because of the current extreme circumstances
• this is being done in their best interests
This should be documented. Please do remember personal safety online and also do make a record of your clinical conversation, assessment and advice. Remember, if making a video consultation call to ensure that you are not unwittingly displaying any sensitive information.
ADVICE
- Clinical advice should be based on evidence based NICE Guidelines, SDCEP and FGDP (UK)
- For a systematic and clinically method use the SDCEP toolkit linked here
Click image for web based toolkit:
ANALGESIA/ANTIBIOTICS- REMOTE PRESCRIBING
These can be advised which in most cases will be over-the-counter medication in accordance with the patient’s medical history using
Where applicable, manage patients in line with local approaches and arrangements for groups that are shielded or at increased risk (eg there may be a prescription delivery service rather than patients travelling outside of home to pharmacies). See Appendix 1.
Please find the following prescribing tools:
WHAT IS DEEMED AN OVERDOSE:
Please check what analgesia patients have taken prior to prescribing. ToxBase is UK National Poisons Information Service please use NIGHT DENTAL login to check if patients have taken an overdose..
- USERNAME: H6222
- PASSWORD: 7VGYA2
Please note password is case sensitive
IBUPROFEN IN COVID-19:
Minimising patient travel is vital during lockdown utilising Remote Prescribing Methods is recommended by NHS and CDO please see the advised pathway
WHEN TO REFER FOR FACE TO FACE
1.SUCCESS OF AAA- Only those who could not successfully managed to AAA including allowing, there are incidences when AAA is not appropriate and patient may be referred direct
2.PATIENT GROUP- Group 1 must be referred to a RED site, we can see group 4 and groups 2/3 should be patient specific. Shielded in morning.
3.URGENT NEED- how severe can it be deferred/ wait for Tx Emergency sent to A&E immediately, type of tx, risk of aerosol- HOT PULPS referred mostly for anterior
4.COMPLEXITY- Only straightforward simple XLAs managed, MAX FAX/ORAL SURGERY Where appropriate for complex/ surgical
5.CAPACITY & AVAILIBILITY- Contact with service manager. Very limited, other options exhausted ahead of F2F . PPE Dependent
REFERRAL:
DIRECT REFERALS
PROFORMA YORKSHIRE & HUMBER- RED/AMBER/BLUE
PROFORMA EAST ANGLIA CTS- RED/AMBER/BLUE
OMFS
