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Protocol for Dental Care in a Domiciliary Setting Responsible head of service: Swarngit Shahid, Clinical Director Name of responsible committee: Professional Advisory Sub-Committee Name of Author Salaried Dental Service Quality and Governance Group Contact for further details: Mrs S Shahid – Clinical Director Version: 2 Supersedes: Domiciliary protocol Date Approved: 17th September 2010 Review due: by 17th September 2013 Key Words: Document type: Dental Domiciliary Protocol If you are using a printed copy of this document please be aware that it may not be the latest version. To view the latest version visit http://nww.bradford.nhs.uk/extranet/Policies/Pages/default.aspx NOTE 1: Clinical guidelines are designed to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances and to support rather than replace clinical judgment and patient choice. In some situations it is right for the practitioner to deviate from the clinical guideline where this is in the best interests of the patient. Where there is doubt advice must be sought. In these cases it is essential that clear records are maintained of the steps taken and supporting rationale. NOTE 2: All clinical guidelines remain valid until notification of an amended clinical guideline is placed on the intranet. Protocol for Dental Care in a Domiciliary Setting v2 ©BACHS 2010 Page 1 of 50 Contents Section Topic Page 1 Introduction 5 2 Aims 5 3 Scope 5 4 Dental care pathway for domiciliary patients 5 4.1 Objectives 5 4.2 Access to domiciliary care 5 4.3 Referring patients for domiciliary care 6 4.4 Processing the referral and assessing the eligibility for domiciliary care 6 4.5 Referral received at clinic 6 4.6 Preparation prior to the visit 6 4.7 The initial visit 7 4.8 Subsequent appointments 10 4.9 Completion of treatment 10 Special considerations when undertaking domiciliary care 10 5.1 Infection control 10 5.2 Medical emergencies in the domiciliary setting 10 5.3 Health and safety 11 6 Procedure for requests for new dentures which have been lost or damaged by the hospital/care home 11 7 References 12 5 Protocol for Dental Care in a Domiciliary Setting v2 ©BACHS 2010 Page 2 of 50 Appendices Appendix Topic Page 1 Care pathway for domiciliary care 13 2 Bradford and Airedale Salaried Dental Service referral form 14 3 Eligibility assessment for domiciliary care 16 4 Decision-making process for domiciliary care 17 5 Pre-appointment questionnaire 18 6 Collecting patient charges on domiciliary visits 20 7 Domiciliary visit risk assessment form 21 8 Assessment of capacity form 23 9 Equipment lists 25 10 Risk assessment for domiciliary instruments 28 11 Manual handling risk assessment form 29 12 Oral health care plan 31 13 Lone worker security policy 32 14 Manual handling risk assessment for domiciliary resources 34 15 Emergency equipment including oxygen carriage 35 16 Procedure for requests for new dentures which have been lost/damaged in the hospital/care home 36 17 Copy of FP17 R/11 form 37 18 Equality impact assessment tool 39 19 Checklist for review and approval 44 20 Document review 45 21 Plan for dissemination of documents 48 22 Dissemination record 49 23 Summary of policy development and consultation 50 Protocol for Dental Care in a Domiciliary Setting v2 ©BACHS 2010 Page 3 of 50 Version Date Author Status 2 Aug 10 B+A SDS Q+G grp For PASC 2 Sept 10 As above Approved by PASC Protocol for Dental Care in a Domiciliary Setting v2 ©BACHS 2010 Comment Page 4 of 50 1. Introduction The strategic direction for driving improvements in the quality of care across the health service is set out in the final report of the NHS Next Stage Review ‘High Quality Care for All’. High quality oral healthcare should be available to all people regardless of their age or circumstances. People with long term and/or progressive medical condition; mental illness or dementia and increasing frailty are not always able to travel to a dental surgery. For some people access to oral healthcare services is achievable only through the provision of domiciliary oral healthcare (British Society for Disability and Oral Health 2009). Bradford and Airedale Salaried Dental Service provide domiciliary care that reaches out to patients who cannot access a service by themselves for reasons of disabilities. The dental care is carried out in an environment where the patient is resident either permanently or temporarily. It will normally include residential units and nursing homes, day centres and the patient’s own home. 2. Aims • To deliver appropriate oral health care provided in a consistent manner to patients whose circumstances make it impossible, unreasonable or otherwise impractical for them to receive care in a fixed clinic. • To deliver care to these patients in the safest and most effective way. • The following document outlines the care pathway available to patients in a domiciliary setting and the associated documentation. The aim is to ensure patients receive timely evidence-based dental care and preventative advice 3. Scope The purpose of this document is to provide guidance to staff within the Bradford and Airedale Salaried Dental Service. 4. Dental Care Pathway for domiciliary patients The care pathway for domiciliary care can be found in Appendix 1 4.1. Objectives The objectives of domiciliary care are primarily to: • Establish a system which will identify individuals in the community who have an oral healthcare need and for whom domiciliary provision is the only reasonable option. • Provide an oral healthcare service to address patients needs, taking into account their personal circumstances and their wishes, consistent with the most appropriate use of resources • Deliver high quality oral healthcare in a person-centred way that respects the dignity of the individual receiving it. 4.2. Access to domiciliary care Liaison with health and social service professionals, carers and the voluntary sector will enable clients who require a domiciliary service to access care. Older people can be referred for domiciliary care by any member of their multidisciplinary team. Care homes should have access to information on local dental services including advice on referrals and information on domiciliary care. Protocol for Dental Care in a Domiciliary Setting v2 ©BACHS 2010 Page 5 of 50 4.3. Referring patients for domiciliary care • Where possible referrals should be made on the Bradford and Airedale Salaried Dental Service form (see Appendix 2). As this will provide the information needed to care for the patient in an appropriate and timely manner. • In case of emergencies verbal referrals can be accepted and the form completed later. Urgent referrals can be difficult to fit into an already scheduled working day and both eligibility for a visit and the degree of urgency will need to be assessed (see section 4.5 below and Appendix 3). Any verbal referrals or urgent requests must be forwarded to the Dental Office for monitoring purposes. 4.3.1. Referrals are accepted for: Patients who: • Have a General Medical Practitioner (GMP) in the Bradford and Airedale district • Would find it impractical or impossible to attend the dental surgery for dental treatment ie for some patients with: o Physical and learning disabilities o Mental health problems eg Alzheimer’s disease, agoraphobia o Medical conditions eg terminal illness, chronic obstructive airway disease. o Patients in hospital, palliative care units and nursing homes (who are unable to access the General Dental Service) 4.3.2. Referrals are not accepted for: Patients who: • are able to access the dental surgery • are able to travel to the dental surgery with assistance • claim benefit to allow them to access health services such as the mobility component of Disability Living Allowance. 4.4. Processing the referral and assessing the eligibility for domiciliary care Referrals for Domiciliary Care follow the standard process for Bradford and Airedale Salaried Dental Service (K Drive/SDSDental/Access/Managing referrals). Once the referral has been received at a member of the triage team will contact the patient and assess their eligibility for domiciliary care using the eligibility questionnaire (Appendix 3). Once this has been completed the questionnaire is reviewed by a dentist or other appropriate person, and a decision is made whether the patient should be assessed at home, or scheduled to attend the clinic. The flow chart ‘Decision Making Process for Domiciliary Dental Treatment’ (Appendix 4) can be used by the clinician to help make an appropriate decision. Once eligibility has been confirmed the patient referral is forwarded to the appropriate clinic. 4.5. Referral received at the clinic Once the referral is received at the clinic the patient details are placed on the domiciliary waiting list. Patients deemed by the clinician to need urgent assessment (patients who have a condition recognised as urgent or emergency using the Department of Health Guidelines) should be seen as soon as practicable by any available dentist. 4.6. Preparation prior to the initial visit. When the patient comes to the top of the waiting list they or in some circumstances the carer/s are contacted by the receptionist/dental nurse to arrange an appointment. At this time a pre- Protocol for Dental Care in a Domiciliary Setting v2 ©BACHS 2010 Page 6 of 50 appointment questionnaire (Appendix 5) is completed with the patient/carer. This provides information to ensure the dentist has sufficient information to plan the initial visit appropriately. At this initial contact it is imperative to ascertain whether the patient is exempt from NHS dental charges. If dental charges are to be made then the patient/carer should confirm how a payment will be made on the first visit. It should be explained to them that full payment for treatment received must be made prior to completion of the course of treatment i.e. fitting of dentures. 4.7. The initial visit. The purpose of the initial visit is to assess the patient’s needs in terms of their physical needs, ability to accept and cope with treatment and their clinical needs to achieve satisfactory oral health. A domiciliary risk assessment is carried out at the initial visit (see below) and this informs the subsequent risk-benefit analysis for providing domiciliary care. 4.7.1. Before leaving the clinic • Telephone the patient at the beginning of the day to confirm the timetable. • Confirm how (unless patient is exempt dental NHS charges) payment is going to be made at the first visit. See Appendix 6 - Collecting patient charges on domiciliary visits. • For security provide the name of dentist visiting. • Try to be punctual. If a delay is anticipated, then telephone to apologise, explain and reassure that the appointment will still be kept; carers may have made special arrangements to be available for a particular time. • Ensure every member of the dental team has their official identification. • Provide a responsible person with the details of where you are visiting and your estimated return time, and contact numbers for you if you do not return on time. 4.7.1.1. Clinical records and administration The following should be taken to the assessment appointment • Clinical record card • Medical history forms • PR11 form • FP17DC • Domiciliary risk assessment form (Appendix 7) • Assessment of capacity form (Appendix 8) A full list of administrative items can be found in Appendix 9 ‘Domiciliary Kits’ 4.7.1.2. Equipment The exact equipment that you will need will depend on the needs of the patient and whether you may need to conduct any emergency treatment. For domiciliary care the equipment is organised into kits (Appendix 9). The minimum required is as follows: • General kit • Emergency kit • Administrative kit Further information regarding the equipment kits and risk assessment can be found in Appendix 10 ‘Risk Assessment for Domiciliary Instruments’ Protocol for Dental Care in a Domiciliary Setting v2 ©BACHS 2010 Page 7 of 50 4.7.2. Assessing the patient On arrival the dental team should introduce themselves and show the patient or their carer their ID badges. Positively identify the patient and ascertain any carers relationship to the patient. Following introductions the following sequence should be carried out. Some aspects are explained more fully in subsequent sections. • Explain to the patient/carer that before you examine them you need to undertake a domiciliary risk assessment to ensure that it is safe for them and for you to undertake treatment away from the surgery. (Appendix 7) o complete the environment/safety assessment o complete the manual handling section and if a risk is identified a formal manual handling risk assessment will need to be carried out. For further information please see NHS Bradford and Airedale Manual Handling Policy which can be found at: http://nww.bradford.nhs.uk/extranet/Policies/Published%20Policies/Manu al%20Handling.pdf The Manual Handling Risk Assessment form is enclosed in Appendix 11 • Confirm the patient’s exemption or if needed take payment from the patient at Band 1 charge. • Complete the necessary paperwork i.e. PR form • Confirm the medical and dental history with the patient, if there are any concerns about the patient’s ability to provide a reliable history this should be discussed with the carer. • Assess the patient’s capacity to consent to an examination, and consider their capacity to consent to any treatment needed. (see section 4.7.4.1) • Carry out a full dental examination and provide a Personal Dental Treatment Plan with estimate of treatment charges (FP17DC) to the patient. You may wish to outline or provide an initial treatment plan to the patient at this stage particularly if the treatment required is complex or if the treatment the patient needs is to be a combination of clinic and domiciliary care. • If able carry out any necessary urgent dental care needed 4.7.3. Treating patients in the domiciliary setting Any treatment carried out must be in the best interests of the patient, and be able to be completed safely from a patient and clinician perspective 4.7.3.1. Treatments suitable for a domiciliary setting The following can normally be safely carried out in a domiciliary setting: • Examination • Temporary dressing • Scale and polish • Oral hygiene advice • Prescriptions • Provision of dentures and related treatments 4.7.3.2. Treatments that may be unsuitable for a domiciliary setting The following treatments may not be suitable for a domiciliary setting. The treating dentist should ensure that if they are carrying out such treatments in a domiciliary Protocol for Dental Care in a Domiciliary Setting v2 ©BACHS 2010 Page 8 of 50 setting that a full assessment of the risks and benefits of the treatment has been carried out, discussed with the patient/carers and documented fully in the clinical notes. • Administration of local anaesthetics • Minor oral surgery • Conservation of teeth where use of air rotas/local anaesthetic is indicated 4.7.3.3. Disputed or unusual treatment plans In cases where there is any disagreement over proposed treatments, the principle of ‘wide consultation’ should be adopted. Where proposed treatments are disputed, could be considered unusual, or would for special reasons fall outside that which may be considered to be within the recognised body of professional opinion, further advice must be sought from senior colleagues, or peers, before proceeding except where over-riding necessity indicates otherwise. 4.7.4. Consent It is the duty of the dentist who proposes to carry out the treatment to ensure that a valid consent is obtained. Consent must be informed, and where a client is considered not to have the capacity to consent, the procedure set out in the Mental Capacity Act (MCA) 2005 must be followed. For further guidance regarding consent please read Bradford and Airedale Community Health Services ‘Consent to Examination and Treatment Policy’ available at: http://nww.bradford.nhs.uk/extranet/Policies/Published%20Policies/Consent%20to%20E xamination%20and%20Treatment.pdf 4.7.4.1. The Mental Capacity Act 2005 Full information regarding the Mental Capacity Act (MCA) can be found in NHS Bradford and Airedale clinical guideline ‘Mental Capacity Act 2005’ available at: http://nww.bradford.nhs.uk/extranet/Policies/Published%20Policies/Mental%20Capa city%20Act%202005.pdf This Act came into force in 2007 and the law applies to everyone involved in care, treatment or support of people aged 16 years or over in England and Wales who lack capacity to make all or some decisions for themselves. There is an assumption that people have the capacity to make decisions for themselves unless proved otherwise. An assessment regarding capacity should be made and supported by the use of a tick box checklist within the patient’s dental records (see appendix 8). The law states that a person is unable to make a particular decision if they cannot do one or more of the following: • Understand information given to them • Retain that information long enough to be able to make the decision • Weigh up the information available to make the decision • Communicate their decision – this could be done by talking, using sign language or even simple muscle movements such as blinking an eye or squeezing a hand. Healthcare workers are able to diagnose conditions and carry out treatment for patients who do not have capacity as long as they have complied with the MCA, and are acting in the individual’s ‘best interests’ Protocol for Dental Care in a Domiciliary Setting v2 ©BACHS 2010 Page 9 of 50 The following check list may be used to determine what is in the ‘best interests’ of a person lacking capacity: • Involve the person who lacks capacity • Consult with others involved with the care of the person • Do not make assumptions based solely on a person’s age, appearance, condition or behaviour • Be aware of the person’s past and present wishes and feelings • Give consideration to whether the person is likely to regain capacity to make the decision in the future • The individual must be supported to make a decision as far as possible even if it is what others may feel is an unwise decision • The decision must be recorded in writing 4.8. Subsequent appointments At subsequent appointments the following should be checked to ensure no changes have taken place, and therefore treatment can proceed: • Risk assessments • Consent and capacity to consent 4.9. Completion of treatment At completion of treatment the patient or carer is provided with a copy of the patients ‘oral health care plan’. This is a duplicate form, completed by the dentist recommending the individual’s care plan to maintain oral health (Appendix 12). The review or recall period will be documented on this form in accordance with NICE guidelines (National Institute of Health and Clinical Excellence 2004). 5. Special considerations when undertaking domiciliary care Undertaking treatment in patients’ homes or care homes means additional factors need to be taken into consideration. The normal facilities of the dental surgery are not present and therefore it is essential that the following are taken into consideration when assessing and treating patients outside the clinical setting. 5.1. Infection Control Infection prevention management within the domiciliary environment must be maintained. If the environment prevents this, treatment must be delivered from another appropriate setting or a formal infection control risk assessment should take place and reasonable adjustments made that do not compromise the safety of patients, staff, carers or the legal obligations of the organisation or individuals. For further information please consult the Bradford and Airedale Community Health Services ‘Infection Control Management Policy’ available at: http://nww.bradford.nhs.uk/extranet/Policies/Published%20Policies/Infection%20Prevention %20Management.pdf 5.2. Medical emergencies in the domiciliary setting Medical emergencies can occur and at any time in premises where dental treatment takes place. The nature of the patients being treated in a domiciliary setting means that there could be a greater chance of encountering a medical emergency. All staff undertaking treatment in patient’s homes must ensure they are trained and competent in dealing with Protocol for Dental Care in a Domiciliary Setting v2 ©BACHS 2010 Page 10 of 50 collapsed patients. The following equipment must be available for use when assessing and treating patients in the domiciliary setting: • Portable suction apparatus to clear the oro-pharynx • Oral airways to maintain the natural airway • Ambu-bag and face masks • A portable source of oxygen • An emergency drug kit • Portable Automated External Defibrillator (AED) • Mobile phone to ensure emergency services can be contacted For further information please read Bradford and Airedale Community Health Services ‘Resuscitation Policy and Procedures for Adults, Children and Infants’ available at: http://nww.bradford.nhs.uk/extranet/Policies/Published%20Policies/Resuscitation%20for% 20Adults,%20Children%20and%20Infants.pdf 5.3. Health and Safety Health and Safety standards must be maintained within the domiciliary environment and a formal risk assessment must be carried and document at the initial visit. Risk assessments must be reviewed and updated at each visit. All Health and Safety issues must be assessed with particular emphasis on: • • • • • • Lone working (Appendix 13) Environment Manual Handling people and equipment (Appendix 14) Vehicle Insurance Emergency equipment including oxygen (Appendix 15) Chaperoning Further details are included where indicated above. Please consult the following documents for more information: NHS Bradford and Airedale Health and Safety Policy http://nww.bradford.nhs.uk/extranet/Policies/Published%20Policies/Health%20and%20Safet y.pdf NHS Bradford and Airedale Manual Handling Policy http://nww.bradford.nhs.uk/extranet/Policies/Published%20Policies/Manual%20Handling%2 0-%20App10d%20Risk%20Assessment%20Form%20V1.pdf NHS Bradford and Airedale Lone Working Policy http://nww.bradford.nhs.uk/extranet/Policies/Published%20Policies/Lone%20Working.pdf 6. Procedure for requests for new dentures which have been lost in the Hospital/Care home The procedure for re-making dentures which have been lost by a care home is explained in Appendix 16. The replacement appliance refund claim form for patients is included in Appendix 17 Protocol for Dental Care in a Domiciliary Setting v2 ©BACHS 2010 Page 11 of 50 7. References Bradford and Airedale Salaried Dental Service, 2009 Advanced Treatment Protocol Bradford and Airedale NHS Infection Prevention and Control Management Policy (2007) British Society for Disability and Oral Health: Guidelines for the Delivery of a Domiciliary Oral Healthcare Service August 2009 Department of Health Implementing Local Commissioning For Primary Care Dentistry Factsheet 7: Commissioning out-of-hours services Gateway Reference 5917 Department of Health and the British Association for the Study of Community Dentistry Guideline 2009. Delivering Better Oral health: An evidence-based toolkit for prevention (283540) [internet] 2nd Edition Published April 2009 Available at http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/ DH_102331 [accessed 1st October 2010] General Dental Council Standards for Dental Professionals 2009. http://www.gdcuk.org/NR/rdonlyres/1B66D814-A197-4253-B331A2DB7F3254DC/0/StandardsforDentalProfessionals.pdf [accessed 1st October 2010] Joint Formulary Committee September 2008 British National Formulary 56 BMJ Group London Mental Capacity Act. Department of Health 2005 http://www.dh.gov.uk/en/SocialCare/Deliveringsocialcare/MentalCapacity/MentalCapacityAct20 05/index.htm [accessed 1st October 2010] National Institute of Health and Clinical Excellence 2004 Dental recall – Recall interval between routine dental examinations http://www.nice.org.uk/nicemedia/live/10952/29488/29488.pdf [accessed 1st October 2010] Protocol for Dental Care in a Domiciliary Setting v2 ©BACHS 2010 Page 12 of 50 Appendix 1 – Care pathway for domiciliary care Protocol for Dental Care in a Domiciliary Setting v2 ©BACHS 2010 Page 13 of 50 Appendix 2 – Bradford and Airedale Salaried Dental Service Referral form Protocol for Dental Care in a Domiciliary Setting v2 ©BACHS 2010 Page 14 of 50 Protocol for Dental Care in a Domiciliary Setting v2 ©BACHS 2010 Page 15 of 50 Appendix 3 – Eligibility assessment for Domiciliary Care Protocol for Dental Care in a Domiciliary Setting v2 ©BACHS 2010 Page 16 of 50 Appendix 4 – Decision–making process for Domiciliary Care Protocol for Dental Care in a Domiciliary Setting v2 ©BACHS 2010 Page 17 of 50 Appendix 5 – Pre-appointment questionnaire Protocol for Dental Care in a Domiciliary Setting v2 ©BACHS 2010 Page 18 of 50 Protocol for Dental Care in a Domiciliary Setting v2 ©BACHS 2010 Page 19 of 50 Appendix 6 – Collecting patient charges on domiciliary visits Protocol for Dental Care in a Domiciliary Setting v2 ©BACHS 2010 Page 20 of 50 Appendix 7 – Domiciliary visit risk assessment form Protocol for Dental Care in a Domiciliary Setting v2 ©BACHS 2010 Page 21 of 50 Protocol for Dental Care in a Domiciliary Setting v2 ©BACHS 2010 Page 22 of 50 Appendix 8 - Assessment of capacity form Protocol for Dental Care in a Domiciliary Setting v2 ©BACHS 2010 Page 23 of 50 Protocol for Dental Care in a Domiciliary Setting v2 ©BACHS 2010 Page 24 of 50 Appendix 9 - Equipment list Domiciliary kit Organise in sub kits These then are organised into red boxes or agreed appropriate boxes for transportation. All boxes to be officially labelled with clinic details. Kits 1,2 and 3 would be required for all domiciliary visits with addition of kits 4,5,6 and 7 as appropriate. 1. General kit • • • • • • • • • • • • Portable light/pen torch (with additional batteries) Latex-free gloves Alcohol gel hand rub Disinfectant wipes Face masks/visors Plastic aprons Protective eyewear for patient/bib Paper towels Tissues Napkins Clinical waste bags and appropriately labelled red box CSSD tote box for contaminated instruments, appropriately labelled. 2. Emergency kit • • • Portable oxygen cylinder in purpose designed carrying case (hazard notice for vehicle) Portable suction unit with appropriate sundries Emergency resuscitation equipment/drugs kit, including portable defibrillator 3. Administrative (in brief case if preferred) • • • • • • • • • • • • • • • • • Identification badges Map/directions Patient records Laboratory forms Consent forms FP17DC forms PR11 forms Medical history forms Prescription sheet and stamp BNF Mobile phone Pens/pencils Appointment cards Change for parking List of contact numbers Health promotion literature Float Protocol for Dental Care in a Domiciliary Setting v2 ©BACHS 2010 Page 25 of 50 4. Basic exam kit • • • • • • • • • • • • • Dental mouth mirror Dental probe Finger guard Periodontal probe College tweezers Pen torch with additional batteries Light source Hand mirror Vaseline Cotton wool rolls/pellets Gauze squares Toothbrushes Therapeutic agents: Chlorhexidine gel, fluoride varnish 5. Prosthetic Kit • • • • • • • • • • • • • • • • • • • Basic exam kit– see 4 Portable motor hand pieces and burs Safe air heater Disposable scalpel Willis bite gauge Indelible pencil Vaseline Impression materials Impression trays/fixative/mixing equipment Tissue conditioner Plastic bags/gauze squares for impressions Pressure relief paste Bite registration material Shade guide Articulating paper Dental waxes Wax knife Denture trimming kit Denture fixative 6. Conservation Kit • • • • • • Basic exam kit– see 4 Conservation instruments - flat plastic, excavators and tray. Matrix strips/bands Motor hand piece and burs Light source Materials: Temporary dressing materials eg zinc oxide/eugenol cement, GIC, Protocol for Dental Care in a Domiciliary Setting v2 ©BACHS 2010 Page 26 of 50 7. Periodontal Kit • • • • • • Basic exam kit – see 4 Hand scalers Portable motor handpiece and prophy cups/bristle brushes Periodontal probe Ultrasonic scaler plus tips Portable suction, aspirator tips and other associated sundries These guidelines may vary at times but only at discretion of the dentist Protocol for Dental Care in a Domiciliary Setting v2 ©BACHS 2010 Page 27 of 50 Appendix 10 – Risk assessment for domiciliary Instruments Protocol for Dental Care in a Domiciliary Setting v2 ©BACHS 2010 Page 28 of 50 Appendix 11 – Manual handling risk assessment form Protocol for Dental Care in a Domiciliary Setting v2 ©BACHS 2010 Page 29 of 50 Protocol for Dental Care in a Domiciliary Setting v2 ©BACHS 2010 Page 30 of 50 Appendix 12 – Oral health care plan Protocol for Dental Care in a Domiciliary Setting v2 ©BACHS 2010 Page 31 of 50 Appendix 13 – Lone Worker Security Procedure Bradford and Airedale Salaried Dental Service Lone Worker Security Procedure All staff must be aware that they have a responsibility to protect their own personal safety during working hours and must be familiar with and follow the guidance in http://nww.bradford.nhs.uk/extranet/Policies/Published%20Policies/Lone%20Working.pdf and Bradford Salaried Dental Service Domiciliary Procedure. It is important that staff follow a structured security procedure when they;• • • • Work in isolation. Carry out domiciliary visits. Deliver resources. Work in a community setting. Security Procedure 1. A detailed risk assessment must be carried out for all initial visits. This risk assessment must be reviewed and updated before staff carry out subsequent visits. 2. Details of visits must be either placed on the R4 appointment book or in a visit log. It is good practice to have a visual queue to remind colleagues that staff are out on visits e.g. a whiteboard. 3. A responsible person in each clinic must be nominated before staff leave the premises/ clinic i.e. dental receptionist, senior nurse or a colleague. 4. The responsible person must be informed of the details of staff visits with estimated departure and return times. 5. Staff must leave the following information with the responsible person:• • Mobile telephone numbers Car registration, make and model 6. Fully charged mobile telephones and personal alarms must be taken on all visits. 7. Any changes to scheduled visits must be reported to the appointed person immediately and local records updated. 8. Staff working in a community setting (including out of hours) must inform a senior member of staff (responsible person) of their proposed timetable. Staff must inform the responsible person when they start and finish their shift. This can be via text or they can ring the responsible person. Protocol for Dental Care in a Domiciliary Setting v2 ©BACHS 2010 Page 32 of 50 9. If staff do not return / or contact the responsible person within half an hour of their estimated time the responsible person should try to contact staff on their mobile telephone. 10. If staff can not be contacted the responsible person must trace the staff movements by contacting each patient / client on the visit schedule. 11. If the responsible person can still not contact staff then they should contact their manager and the police immediately. 12. Personal details for all staff will be available from the dental office or the senior dental nurses offices at Horton Park. 13. If the responsible person is not working in the location for the duration of the staffs visits they must hand over their responsibility to a colleague before they leave. Protocol for Dental Care in a Domiciliary Setting v2 ©BACHS 2010 Page 33 of 50 Appendix 14 – Manual Handling Risk Assessment for handling domiciliary resources Protocol for Dental Care in a Domiciliary Setting v2 ©BACHS 2010 Page 34 of 50 Appendix 15 – Emergency equipment including oxygen carriage Protocol for Dental Care in a Domiciliary Setting v2 ©BACHS 2010 Page 35 of 50 Appendix 16 - Procedure for requests for new dentures which have been lost/damaged in the Hospital/Care home For patients who are exempt from dental charges: Process the examination and denture construction as normal under a Band 3 treatment. For patients who are not exempt from patient charges: The construction of a new denture should be processed as a ‘Regulation 11 replacement’ On R4 when you open up the patient’s record, and choose examination type the box ‘Replacement appliance’ or ‘Two Replacement appliances’ should be ticked depending on whether one or two dentures are being constructed. One of the boxes shown should be ticked to indicate if one or two dentures are being replaced A charge will be generated on the treatment plan; £59.40 for a single denture, £118.80 for two dentures. If the denture was not lost or damaged due to lack of reasonable care by the patient they are able to claim a refund for the denture/s from the Business Services Authority by completing form FP17 R/11 which is included in Appendix 15. Copies of the refund form can be printed from: http://www.nhsbsa.nhs.uk/DentalServices/Documents/DentalServices/FP17R11_FRONT _271008.pdf Protocol for Dental Care in a Domiciliary Setting v2 ©BACHS 2010 Page 36 of 50 Appendix 17 - Copy of FP17 R/11 form Protocol for Dental Care in a Domiciliary Setting v2 ©BACHS 2010 Page 37 of 50 Protocol for Dental Care in a Domiciliary Setting v2 ©BACHS 2010 Page 38 of 50 Appendix 18 - Equality Impact Assessment Tool NHS BRADFORD AND AIREDALE Equality Impact Assessment Toolkit STAGE ONE SCREENING/TESTING FOR RELEVANCE Guidance An equality impact assessment is a way of systematically assessing, and consulting on the effects that a proposed policy, strategy, tender or procedure is likely to have on a diverse range of communities and individuals in the District. The principles that underpin the Equality Impact Assessment process are those that promote inclusion and meaningful participation. They are directed towards making a sustained effort at eliminating inequitable health outcomes and eradicating unfair treatment. The ability to treat all users and staff with respect and dignity, and provide them with choices that are responsive and appropriate is a fundamental requirement of the Human Rights Act 1998 Stage 1 of the screening applies to all policies, strategies, tenders, or procedures. The aim of this is to test the relevance of impact against the equality target groups. In stage 1 available data will be interrogated, relevant research will be consulted together with any anecdotal feedback that may help form an opinion about the impact a policy, strategy, tender or procedure may have on any of the equality target groups. Gathering evidence is a key to assessing progress and defining expected equality outcomes. Where data is limited or not available reviewers should identify this as a limitation and schedule this as further evidence needed. The legal duties require policy authors to use information/ data to determine the effect of the policy on equality and diversity. Previous data used to monitor the policy can be used in support of this element of the review. Data can be statistical or qualitative information from audits and consultation exercises. Consultation and engagement is required at all stages of policy development. This stage involves screening the policy, strategy, tender or procedure for relevance against the equality target groups. If you require further assistance you should contact the Equality and Diversity Team: Protocol for Dental Care in a Domiciliary Setting v2 ©BACHS 2010 Page 39 of 50 NHS Bradford and Airedale Equality Impact Assessment Flowchart In its design or implementation stage, does it intentionally or unwittingly discriminate against particular groups of people, e.g., men, women, disabled people, people from different ethnic groups and religions, age groups, and sexual orientation? Conduct a FULL EQIA UNCERTAIN YES Ask those most affected, and consult relevant staff, patients, VCS, and other users NO HOW DO YOU KNOW? Data Staff Users Scanning No need to change this policy at present, though remember to keep it under review. You will need to change this policy, practice or procedure so that any adverse impact is removed Protocol for Dental Care in a Domiciliary Setting v2 ©BACHS 2010 Page 40 of 50 Stage One: Screening of a policy, procedure, tender or a strategy • 1. Name of policy, procedure, tender or • strategy Based on national document 3. Who has been consulted? Protocol for dental care in a domiciliary setting • Is it a policy, strategy, procedure or practice? Protocol • 2. Main Aims • 4. How has the policy been explained to those most likely to be affected? Safe treatment of patients in the domiciliary setting N/A Protocol for Dental Care in a Domiciliary Setting v2 ©BACHS 2010 Page 41 of 50 Collecting and collating existing information and data Please indicate in the table below whether the policy, strategy, procedure or tender has the potential to impact adversely on the equality target groups Equality Target Group 1. Is the policy likely to have a potential differential impact with regards to the equality target group listed? O = No 1 = Little 2 = Medium 3 = High 2. How have you arrived at the conclusions in box 1? i. Who have you consulted? (appropriate individuals/groups internally and externally) ii. What have they said? iii. What information/data have you interrogated? (library search, complaints data, PALS, research reports, local studies, advice from internal and external specialists) iv. Where are the gaps in your analysis? v. How will your paper promote the equality duties if they apply? There have been no concerns expressed to the SDS about the access criteria for domiciliary care, where possible we do try to assess patients in their homes but as we are very restricted on what can be done outside the surgery patients do understand that they have to come in for at least some of their care. If a referral is received for domiciliary care we generally do an initial assessment so we can ascertain which level of care is appropriate for the patient. If a patient can come in we would do the assessment in the clinic but some treatment items may be carried out in patient’s homes. We have a current programme of patient involvement with groups that would use the service such as nursing homes and learning disabilities groups and this is to promote the service. There have been no access problems reported. Age Older people Young people Children Early years Disability Sensory disabilities Physical disabilities Learning disabilities Mental health Gender Men Women Transgender 0 No adverse affect - Mainly elderly/infirm patients that would access this service No adverse effect – Service has a positive impact on patients with disabilities unable to access regular dental care 0 All patients have equality of access to this service 0 Protocol for Dental Care in a Domiciliary Setting v2 ©BACHS 2010 Page 42 of 50 Race Minority Ethnic Communities Gypsies & Travellers Religion or Belief Christian Muslim Hindu Buddhist Sikh Jew Other Sexual Orientation Lesbian Gay men Bisexual All patients have equality of access to this service 0 All patients have equality of access to this service 0 All patients have equality of access to this service 0 Summary 8) Is a more Full Equality Impact Assessment Required? No Yes 9) Please describe the main points arising from the initial screening here that support your decision in box 8 This protocol is for domiciliary dental treatment and does not adversely affect equality of access or treatment Response to main action points: 1. Signature of Policy Lead conducting impact assessment: Lucie Godber 2. Approved by Equality and Diversity Lead: Lynne Carter Date: 13.10.10 Protocol for Dental Care in a Domiciliary Setting v2 ©BACHS 2010 Page 43 of 50 Appendix – 19 Checklist for the Review and Approval of Documents Individual Approval If you are happy to approve this document, please sign and date it and forward to the chair of the committee/group where it will receive final approval. Name Lucie Godber Signature Lucie Godber Date Aug 2010 Committee Approval If the committee is happy to approve this document, please sign and date it and forward copies to the person with responsibility for disseminating and implementing the document and the person who is responsible for maintaining the organisation’s database of approved documents. Name Date Signature Acknowledgement: Cambridgeshire and Peterborough Mental Health Partnership NHS Trust Protocol for Dental Care in a Domiciliary Setting v2 ©BACHS 2010 Page 44 of 50 Appendix 20 - Document Review Title of document being reviewed: 1. Yes/No/ Unsure Comments Title Is the title clear and unambiguous? Yes Is it clear whether the document is a guideline, Yes A protocol Yes In introduction policy, protocol or standard? 2. Rationale Are reasons for development of the document stated? 3. Development Process Is the method described in brief? No Are people involved in the development No identified? Do you feel a reasonable attempt has been Yes made to ensure relevant expertise has been used? Is there evidence of consultation with No stakeholders and users? 4. Content Is the objective of the document clear? Yes Is the target population clear and Yes unambiguous? 5. Are the intended outcomes described? Yes Are the statements clear and unambiguous? Yes Evidence Base Is the type of evidence to support the Yes document identified explicitly? Protocol for Dental Care in a Domiciliary Setting v2 ©BACHS 2010 Page 45 of 50 Title of document being reviewed: 6. Yes/No/ Unsure Are key references cited? Yes Are the references cited in full? Yes Are supporting documents referenced? Yes Comments Human Resources If appropriate have the joint Human N/a Resources/staff side committee (or equivalent) approved the document? 7. Summary of Guidance Is there a quick reference guide, key N/A recommendations or flow chart summarising the document? (not obligatory, but may be helpful for some documents) 8. 9. Format Is the document in an easily readable font? Yes Is there an appropriate footer on each page? Yes Is it easy to find sections within the document? Yes Patient Information Does the document require patient Yes information? If so, does it make clear what information and how this should be presented? 9. Dissemination and Implementation Is there an outline/plan to identify how Yes dissemination and implementation will be done? Protocol for Dental Care in a Domiciliary Setting v2 ©BACHS 2010 Page 46 of 50 Title of document being reviewed: Does the plan include the necessary Yes/No/ Unsure Comments N/A training/support to ensure compliance? 9. Process to Monitor Compliance and Effectiveness Are there measurable standards or KPIs to N/A support the monitoring of compliance with and effectiveness of the document? Is there a plan to review or audit compliance Yes with the document? 11. Overall Responsibility for the Document Is it clear who will be responsible for co- Yes ordinating the dissemination, implementation and review of the document? Protocol for Dental Care in a Domiciliary Setting v2 ©BACHS 2010 Page 47 of 50 Appendix 21 - Plan for dissemination of documents Title of document: Bradford and Airedale Salaried Dental Service Protocol for Dental Care in Domiciliary Setting Date finalised: Dissemination lead: Previous document Print name and contact already being used? If yes, in what format and where? Yes details Paper format in clinics Proposed action to retrieve out-of-date copies of the Will recall through Clinical Rep Group document: How will it be To be disseminated disseminated, who Paper to: will do it and or Electronic Comments when? Quality and Governance Group Staff of Salaried Dental Service Professional and Clinical Development meeting Both On K drive and on PCT Policy Library Via operational update Protocol for Dental Care in a Domiciliary Setting v2 ©BACHS 2010 Page 48 of 50 Appendix 22 - Dissemination Record Date put on register of Date due to be documents reviewed Disseminated to: Format (i.e. Date No. of Contact Details / (either directly or paper or Disseminated Copies Comments via meetings, etc) electronic) Protocol for Dental Care in a Domiciliary Setting v2 ©BACHS 2010 Sent Page 49 of 50 Appendix 23 - Summary of Policy Development and Consultation This protocol has been developed by the Bradford and Airedale Salaried Dental Service Quality and Governance Group. The group consists of the following members: Bradford and Airedale Salaried Dental Service Clinical Director Assistant Clinical Director Specialist in Paediatric Dentistry Senior Dentist (Adult Special Care) Operations managers Oral Health Promotion Manager Members of the dental team who undertake domiciliary care have been instrumental in the development of the protocol alongside the wider dental team involved in Adult Special Care. Protocol for Dental Care in a Domiciliary Setting v2 ©BACHS 2010 Page 50 of 50