Hampshire and Isle of Wight LDC

Local Dental Committee

Hampshire and IOW LDC – Return to Clinical Practice Suggestions

By

HAMPSHIRE AND ISLE OF WIGHT LOCAL DENTAL COMMITTEE: 29.05.20

 

RETURN TO CLINICAL PRACTICE SUGGESTIONS

Tips and thoughts on re-opening from a UDC hub and private practice

PREPARING THE PRACTICE

  1. Read the Standard Operating protocol on The LDC web site. Take heed of all the OCDO letters
  2. Check the local SOP every two weeks as it becomes updated
  3. Look at other SOP’s
  4. Do not down grade the SOP’s but can they be improved upon in your practice?
  5. SOP is a living document. Update regularly but save each new version under new name. (Ensures you can return to reasons why something was done on certain date.)
  6. Do not just copy the SOP, it must be your practice-based document.
  7. Get all staff to read and sign that they understand.
  8. Encourage challenges and input from staff
  9. Consider decisions document where updates are noted and why,
  10. Do not operate an open-door policy at this time, as you cannot control who is entering the building.
  11. Contact patients by phone the day before
  12. Explain changes that they will see and what is expected of them
  13. Get medical histories updated on-line beforehand (SoE Portal)
  14. Get staff to run through a Covid health check list, isolating, recovery, shielded. Template
  15. Get a good idea of what they are coming in for, photos via email. Template
  16. Encourage patients to use the toilet at home (and clean teeth!)
  17. Wait in the car
  18. Patient to phone the practice from the carpark and wait until invited in
  19. Temperature and hand sanitiser by staff at door. Record on Covid risk assessment in clinical record. Template.
  20. Make sure reception shields are ordered soon, they are in shorter supply than PPE
  21. Check staff availability soon as they may have child-care issues. This has been a big issue for us
  22. Arrange face fit testing now of all clinical staff. Do not wait until the last minute
  23. Have a Zoom conference with staff to talk through the changes.
  24. Phone staff individually to check on any unanswered issues. Reassurance
  25. Bring small number of staff in for the opening period, ask their views
  26. Do a dummy run to see what works well and need changes. Practise again.
  27. Be realistic about timing of procedures and cleaning time
  28. How many per day, 8 patients maximum at this time is appropriate
  29. Consider installing bell from surgery to reception to summon another member of staff if additional material/equipment is necessary
  30. Consider ventilation/air conditioning/windows open/air cleaning unit installation
  31. Consider small steam cleaner for floors. Shark from Lakeland is brilliant
  32. Update cross infection control policy
  33. Update mental health policy
  34. Update hand hygiene policy
  35. Use the BDA page on being ‘safe at work,’ bring pillowcase to take scrubs home for washing
  36. Sticky sheet covers for credit card machine pad
  37. Minimise time in reception area
  38. Send receipts and appointments and follow up instructions by email to minimise time
  39. Scheduling so patients do not meet in waiting room
  40. If possible, separate entrance and exits.
  41. Consideration on how to obtain signatures for MH’s and Consent for treatment plans if unable to use electronic signatures.
  42. Consideration to working in ’bubbles’ (nurse/dentist/ receptionist) if a multi chair practice due to impact of track and trace
  43. Protocol for using the staff kitchen- wash hands thoroughly on entrance into kitchen and wipe down kettle, fridge and door handles after use.
  44. Option of bringing food with chilled bag to avoid sharing fridge
  45. Use the time to update your web pages explaining the changes you have made for patient safety.
  46. Consider a short (or longer) video. The dentist may not be the best person to present it!!
  47. Check all cordless devices (curing lights, endodontic motors etc) as they have probably lost their battery charges.
  48. While the practice is unused, increase the water temperature on the boiler and run very hot water through the taps to reduce bacterial load in static pipes. Remember to turn to a safe temperature for patients.
  49. Ensure dental unit water lines have deep clean flushed through them, not just the daily additives (for example Bilpron against normal Alpron with Biotest to verify.)
  50. Beware of suppliers quick links to PPE webpages. They CAN take you to the most expensive masks and gloves. Search normally.
  51. Disinfection of plastic/silicone respirator masks can be carried out using a small ozone generator in a box for 20 minutes. These are made for sleep apnoea machines. ‘Rescomf’ on eBay is about £35.
  52. Justify the type of mouthwash being used, pre-treatment and every 30 minutes during treatment if not using rubber dam.
  53. Use only a small amount of mouth wash. Consider CleanCert’s Orawize as if is economical.
  54. Decide if rinsing into the spittoon (with splashes) or back into the mouthwash cup

BOOKING PATIENTS

Consider who will be offered initial treatment, not on the basis or persistence and annoyance.

Identify the patients and make a record of their status and why they were prioritized.

Allocation could be into groups such as

  • Shielded patients
  • Patients at increased risk from COVID-19
  • Patients with urgent dental care needs
  • Patients who have contacted the COVID-19 UDC system and already been triaged for urgent dental care or require follow up care
  • Patients with incomplete treatments
  • Patients with frequent recall (high needs both caries and periodontal.)
  • Patients with routine dental care needs, not applicable to any of the above.

 

 

 

 

 

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