Welcome to the Association of Dental Administrators and Managers

Hi Denise, in response to your e-mail l really think this new PM is expected to do too much in order for her to do the job efficiently.  Although being a fully private practice they may have very long appointments which would ease the stress, to be honest, l really think Andre her dentist should at least employ a nurse to free this new PM to go on proper training courses to guide her so that she will be confident and professional at all times.  Yes a PM has to be flexible and able to turn her hand to all the various jobs within the practice but if she is expected to run the place single-handed then she will end up hating her job and becoming a nervous wreck.  Some principals in practice really have no idea what a PM needs to know and carry out in order for the business to be successful.  I also think he needs to spend a few bob on a cleaner for goodness sake, those days are gone.  She sounds very confident and so enthusiastic which is great, l wish her the very best.

I would personally delegate this course to another dental nurse in the practice.  Practice management takes up a lot of time and really with this qualification under your wing, when would time allow you to take radiographs? Not only that but it would tie you into the nursing role when what you need is PM training.  Delegating this to another dental nurse in the practice would free you up at difficult times, and also avoid you unnecessarily being interrupted to take radiographs. I have a nurse doing the course at the moment.

Here are some task sheets prepared by some PMs that may be useful

Reception tasks to be done daily

• Purchase newspaper and milk (flowers on a Monday morning £10.00)
• Open up surgery at 8.45am
• Turn off alarm
• Switch off answer phone
• Take out petty cash tin
• Have spreadsheet ready for the day
• Have PC and Receipt envelope ready for the day
• Have receipt book at hand for payments
• Make sure all auxiliary staff have signed their time sheets
• Make sure all the day sheets and cards are ready and pulled
• Make sure that on the days that X works she is given a stock record report to chart sales of sundries – Place this with her cards for the day
• Confirm all appointments for the following day – If you have to leave a message try again later in the day
• Liaise with labs regarding deliveries or collections (on instruction of the dentist)
• Make sure all lab work is written up on lab book and that it is signed for on collection and delivery
• Open up the post – separate the junk mail from statements and invoices, file the bills in alphabetical order either current or past.  This must be done methodically to avoid loss of invoices.  Letters of importance must be placed in an envelope for principal’ attention
• Do recalls on a daily basis – Do not file any cards that require recalls
• Check all patients information with them regarding address and phone numbers
• Do the filing daily to avoid piles of cards laying around
• Make sure that petty cash expenditure balances at the end of the day with the daily spreadsheets turnover for the day – Update the petty cash report on excel daily
• At the end of the day add up all the takings and cross check the totals make sure that they balance – Update spreadsheet on excel daily.
• Float to be put back to £40.00
• Lock petty cash tin and mobile away for safekeeping.  Place the key in the agreed spot
• Print end of day bank reconciliation off streamline terminal and place in envelope with petty cash and credit card receipts for filing
• Place daily spreadsheet in weekly envelope and file for safe keeping with the above envelope attached to spreadsheet
• Turn on answer machine
• Check that all plugs, lights and machinery is turned off (This includes the compressor switch in the surgery)
• Close the blinds in all rooms
• Set alarm

Reception tasks to be done weekly

• Purchase flowers on Monday morning – budget £10
• Make sure that the nurses have removed the yellow clinical waste bags from the bin on the balcony – Tied them up and placed them in the spare surgery ready for collection on Monday mornings make sure that the driver signs the collection report and that the information is correct regarding collection items
• Go through current draw and follow up outstanding treatment.  Call patients to book appointments (when the practice is quiet)
• Go through the dormant cards and follow up recalls that pts have not responded to – if pts have been sent several recalls but have not responded within a 2 year period place records into archives.
• When a dentist does not have any patients and a nurse is spare she is to go through the archived records and shred files older than 11 years.  All staples must be removed to avoid damaging the shredder.
• Banking is to be done at the end of Thursday evening (Thursday to Thursday) baring month end when the final deposit will include the last days taking. (i.e. Thursday to Tuesday)
• Bank deposit book must be filled in correctly
• Petty cash must be calculated weekly – PC expenditure must balance with weekly turnover. (takings, minus expenditure = deposit)
• Bank deposit report must be filled in weekly to avoid queries at month end
• Staff time sheets must be added up weekly Monday to Friday (Can do on Monday morning of the following week)
• Weekly practice monitor report must be done Monday to Friday and handed to X on Monday during the course of the day
• Surgery spot checks must be done by X and handed to in on a Friday afternoon ready for X on a Monday morning

Q.I was wondering if anyone could email me a list (daily, weekly and monthly) of what they are asking their receptionist to do.   Ie a check list.  I am finding that some things are just not being done and because there’s no check list I don’t get to find out till its too late!!!

A.I feel your frustration as I find reception can become very sloppy if you don't keep tight reigns on it.

I get them to fill in weekly and monthly checklists covering duties such as recalls, second recalls, reminders, debt chasing, FTA's, incomplete treatments etc. They have to fill in the sheets and initial anything they have actioned with the date, they are kept in a file which I check on. Do you have a lead receptionist?, I appointed one as soon as I came to the practice, therefore you have somebody there who is responsible for ensuring these tasks are done. I also have a dry wipe monthly planner in reception so that tasks are set out on the calendar at specific times of the month, I get our lead receptionist to do this so she has to take responsibility for delegating, and this is refreshed at the beginning of each month.

We actually use the CODE description of reception duties and amend to fit what suits us

August 2015

Q.Does your practice use a Prestige vacuum autoclave, do you find it reliable? We’ve been experiencing issues with ours since new and I wondered if other practices are experiencing the same?

A.We had a string of problems when our C3 first came to us. (We've had it 2 years now) The helix tests failed regularly and the door caused no end of problems until the whole interior door panel was changed. I had to learn basic engineering to lengthen the screws with an allen key every time I change the gasket. However, Prestige were helpful but it did take a long time to get things right.

A.We have had problems with our Prestige vacuum and non-vacuum autoclaves all the time – also the engineers are very slow to respond to calls for repairs. Incidentally we know that a tattoo shop in town also has theirs breaking down all the time!

February 2013

Q.I wonder if any of my colleagues in the south in Private/Denplan practices would share with me the hourly rate they pay their self-employed hygienists. 

We pay £46, but charge them 12% of whatever they earn as surgery and fixed equipment rent.  (Although we will be changing this to a fixed amount).

We also pay them 50% of this for DNA time, but are aware this is not a good idea in respect of their self-employed status.

Would be grateful for anyone's opinions and input.

A.My hygienist is self-employed so we charge £46 for 30 min appt but she is charged 55% for her business cost. This equation is also applied to any fta charges that we may also get. Our business also pays a set fee of £6 to the referring dentist?. 

A.We pay a flat fee of £35 per hour and reserve the right to send them home unpaid for fta's – we condense their day and send them home early if we have no appointments booked or a group of fta's.

December 2015

Q.Do you have any advice on doing price comparisons for your stock ordering? And does anyone have a dress code policy that they are willing to share with me?

A.In regards to stock comparison I simply called up each supplier, Henry Schein, Dental Directory, Red Apple & Try-care (as these were suppliers who we could do our weekly bulk stock order with) and asked what discount they were willing to give us based on an average spend of X and went from there. We use Try-care at present as they are most reliable and can source 90% of the products we use, the remainder comes from optident and QED.

A.I always rather hesitant to do this as I thought it would be time consuming task. However, I have successfully done this myself, and believe others have tried it too.

The best way is to forward the invoices of items that you order regularly to the companies that offered you to review or match the your existing costs so you end up conveniently ordering your regular items from one place rather that bits and pieces through many different ones.

I understand it can be time consuming to get this all sorted but it is well worth it in the end (it certainly worked well for us)

We successfully transferred majority of stock to Precision Dental (based in Borehamwood from Budget Dental). You would think nobody can offer better prices than Budget Dental or Dental Directory but it turns out that it is all possible. You won’t know until you try and I certainly would encourage you to find some time one day and go for it. 

I understand, that you will never be able to just use one company due to the variety of products and individual dentist's/practice's preferences but it would to make things easier with your everyday items/ disposables and it works quite well. Its time saving for you and reduced expenses for the practice.

A.The stock comparison question is a good one and I wish that there was an easy answer!  We have on occasion emailed our whole stock list off to a large supplier to try and reduce the burden of time we spend on ordering.  In reality they have never been able to match the ‘specials’ price that many organisations offer and we have never found one company that covers even 75% of our stock needs so it wasn’t worthwhile.  I guess the corporates will do companywide ordering which may well be easier for them?

Re: Dress code.

Our nurses and clinical staff all wear a tunic (Simon Jersey & Co) – we order and pay for these for them.  If they are full time they have 3-4 and if they are part-time they have 2.  We fund them to buy their own black trousers (fit has always been an issue with ‘work wear’ companies) up to £35 per item.  Generally the staff buy from the high street at shops that are sized appropriately for them – usually this is M&S, Next or Top Shop/Man.  They all wear croc style closed toe shoes, which again we buy.

Reception staff get a one off allowance of £100 to buy smart shirts and trousers/skirts.  We do not have a dress code other than ‘smart’ for reception and admin staff, although we have name badges and a ‘meet the team’ board so that everyone knows who we are.

Finally, we brought a washing machine and tumble dryer a couple of years ago and so staff take it in turns to put a load on – this means that we need less uniform; we cover compliance issues over the temperature that clothes are washed at and moving dirty clothes to and from work.

July 2015

Q.Does anyone have a policy in place about no dogs in the premises except Guide dogs. Really need some advice on this as we have a lady who brings her Chihuahua in a bag into the practice.

A.I know what that feels like… It's like the "smelly food" situation.

With the exception of Guide Dogs (obviously) perhaps the "allergy" card could be played to keep it out the building.

A.We had a similar situation. Offered to look after the dog at reception but mad dog lady wanted to take it into the surgery. We put a No dogs but guide dogs sign up after that, but she wanted us to put her dog in our garden and sit with it. You just can't win with some people.

A.Oh goodness whatever next? A few years back I had an issue present on a guide dog in surgery. I sought lots of advice & our local PCT at the time

Confirmed dogs not allowed in surgery guide or other. After many chats with the partially blind parent of a patient we came to a solution

We saw the patient in our downstairs surgery, at the point they went into surgery the guide dog came and sat with me in my office.

This worked, however to answer your original question – we don’t have a policy. It’s a sensitive area & I personally think needs individual consideration.

A dog in a bag is a no no surely?

A.Just get a guide dogs only sign for front door and write a policy of a few sentences stating guide dogs only. It affects Cross infection control!

A.Yes guide dogs only policy. We have a hook outside the front door and ask people to tie their dog up there (or bicycle). It’s your practice you make the rules. You can also say it is a health and safety issue – which in fact it is.

A.Tell her to take it out or she won't be seen

August 2015

Q.Our practice currently carries out its own on-call during evenings, weekends, bank holidays etc. We are mainly a private practice with around 4500 private patients. Each dentist is on call for their own patients and the dentists cover for each other when they are on holiday etc. We see around 5 patients each week out of hours.

The dentist usually attend the practice and ask the patient to bring a chaperon and in most cases the patients are long standing and well known to the dentist and the practice. However we feel the current situation does have some holes, such as the dentists cleaning up after themselves! 

We are thinking about having one practice mobile phone which a nurse would answer then triage the calls – make the arrangements for the patient to attend the practice by liaising with their dentist – attend the practice to set up, assist then clean down.

I would love to hear from any practices that have a similar system in place to see how they organize it and in particular pay the nurse.

We wish to remaining doing our own on call and the dentists insist on seeing their own patients wherever possible.

A.We have 4 dentists here and approx. 8000 pts – each dentist is on call for a week (on a 4 week rota); we have a pager that the dentist takes home with them and emergency pts phone them. They either offer advice over the phone or come out to the practice to see the pt. No nurses are involved, the dentist works unassisted and tidies up, as best they can afterwards! We probably only see a handful each month, the dentists are happy to see their colleagues pts. We charge for the call-out (smaller amount to Denplan pts and not for children). It has worked here for over 30 years.

It helps if the dentists devise the scheme themselves and are happy with it!

A.We have run a triage system for many years, very often the patient's problem can wait for the next surgery rather than necessitate an emergency call out. If you're seeing 5 patients a week (which seems a lot), is this all at weekends? We keep at least one emergency slot free each day so anyone phoning after hours can be offered an appointment the next morning.

We charge £50 for a call out, plus the cost of treatment, and this is stated very clearly on the answerphone message.

If a call out is necessary then the triage nurse co-ordinates the dentist and patient and then nurses for the appointment.

When I worked in a veterinary practice, we only ever had one vet on call out of hours, at the moment it sounds as though all your dentists are on call unless they're on holiday. Perhaps it might be simpler to have a rota for the dentists as well as the nurses?

You could even have an "emergency clinic" at a set time on a Saturday and/or a Sunday, so any emergencies can all be seen together, which saves on travel etc.

A.This is something we are just setting up now for our private patients.

It is slightly different for us as we are Ortho with an NHS contract, and most of our private patients are adults, with not much cause for emergencies.

We have one mobile phone which will be shared around all the Orthodontists (6 in total), who will be on call with a nurse for a month at a time or on a weekly rota (yet to be decided)

It is also yet to be decided who answers the calls!  Our nurses will be paid for the call on a rota a fixed rate with an additional hourly rate including travel if called in.

A.I can understand the worry if a patient doesn't bring a chaperone, but as long as you advise them to, I can't see we can do anymore really. 

With regards to the dentist having to clear up, we have run an on call service for the last 25+ years, and none of our dentists are too precious to clean up after themselves!!!! I would be very careful about asking nurses to triage as they are then responsible for anything that is told to a patient, and if anything is advised incorrectly or anything is missed the nurse is liable not the dentist, as per our new indemnity rules. It's not a question of the pay it's more the legal side I would be very concerned about. If you were to pursue it the nurse would need pay not only for the time at the surgery but also the time they have to have the phone for calls, and extra as it will be out of contracted hours work. You should have something on their contracts about rates of pay for working outside their normal hours.  

I think you also have to think about if a nurse is down to do the on-call and can't do it, this would mean trying to get someone else to cover or being in the same boat you are now.

I know my email seems negative, but to me just because a dentist doesn't want to clean up after themselves you are opening a large can of worms with potential serious implications for the nurse, you would have to be 100% sure the nurse understand the legal obligation and the potential implications to herself if a patient wasn't happy with something they had said.

May 2015

Q.In relation to Management of Sharps as I understand we are not allowed to re-sheath needles. I wonder what everyone is doing in their practice i.e. using disposable syringes, certain types of needle guards, etc.

Has anyone done sharps risk assessment in their practice that they can share with us?

A.We are using the Septodont safe needle system

A.Hi we are all supposed to be using disposable syringes with needles attached, so you don't need to worry about safety as they cover the needles when finished with.

A.http://m.youtube.com/watch?v=Y3Juossg8Bw

March 2015

Q.Who do you use for your legionella risk assessment and how much does it cost?

A.We use Brodex it is now £135.00 a year but will be more expensive for first year. Phone no 01704 834477

A.We use Bison Environmental. It cost £378 inclusive of VAT for our 2^nd year check

A.Hi there, we use Reef based in Cornwall. It was somewhere in the region of £300.

A.At my practice we use safety shield solutions and have for years, very helpful and they now do all our electrical checks as well. It was 250 plus vat

A.We use Oakleaf Group. Cost is about £250.

A.We use a company called Bison Assist 0800 862 0066

Legionella risk assess     225.00.
Water sampling    30.00
Water sampling for pseudomonad     50.00

All + vat

A.Interserve we pay quarterly £45 per month (although they are a bit slow on the admin side)

A.We've used Jacqui Goss at YES! For the last two RAs. Cost is somewhere between £250 and £300 from memory. Thorough inspection and comprehensive report.

A.I use Bison Environmental, It’s around £250 every 2 years. Very comprehensive and sensible, I would recommend them. And you get a free water thermometer for your monthly audit.

June 2015

Q. Is it now mandatory for a dental practice to have a defibrillator? If so, can anyone recommend a good company to purchase one from?

A.We have one purchased from a company called Martek. They keep us informed of “use by” dates for our replacement batteries and pads. Etc.

A.I've been to CQC course last month and they confirmed that practices must have it; however, in there guidelines, it says 'recommended'. We've bought it last year for the peace of mind through www.defibshop.co.uk

A.Yes it is mandatory, very much so and it has to be checked every day to make sure that the battery is working properly

A.Try this link http://www.primarycaresupplies.co.uk/products/Medical+Equipment+%26+Diagnostics/Defibrillators/Defibrillator+Units? Not sure if they are a good company but prices seem reasonable

A.As far as I’m aware it’s now mandatory. We got ours online from Medisafe – the best price we could find, quick delivery and they stock all the accessories too.

A.If you look on the GDC website under Medical Emergencies it tells you: "Premises in which patients are seen clinically should have a defibrillator." Our PCT provided ours so it might be worth contacting your area team to see what they say. 

A.At our last Medical Emergency training, they had specified it was recommended. I imagine it will eventually become a must which will inevitably increase the cost of them. We bought one through a company called First Medical and they do training on it for you also.

A.Yes it is. We organised it through our med emergency training company

A.It is now mandatory. A lot of Area Teams will supply practices with one, but before this we used The Defib Shop.

November 2015

Q.Does anyone know how to keep KPI records? We are a NHS (90%) and PVT (10%).

If anyone could help me I'd really really appreciate it. Actually it would be lifesaver.

A.Please find a Monthly KPI sheet that I adapt for Practices I work with. (this can be found in the template section of the website)

My suggestion is that if you are completely new to KPIs do not try and implement all at once. You are probably already doing some such as daily revenue and recalls – and I would start by systemising these. Write out why these are done, why the measurements help the Practice to grow – and start to share them with the team.

I suggest that your objective be to work towards monitoring the six KPIs that I've listed below by the end of the year. Again it's important that you and the team understand why this is being done. My view is that these KPIs if updated every four weeks provide a real understanding as to how the Practice is performing and where attention needs to be focussed. Use them as a sign post and then drill down for more information where needed.

And most importantly if your Practice is using a Practice Management Software such as Exact or R4 then the system to generate KPIs should be as automated as is possible.

1. Net Practice Growth – new patient count minus number of patients leaving = net growth

2. New Patient Value – the value of their first treatment

3. New Patient Treatment Plan Take-up – % of patients who take up proposed treatment

4. Average Patient Value – patients must visit at least once a year to be counted

5. Average Daily Yields – gross fees produced per day (regardless of the length of day) by a clinician averaged over the day the clinician actually works

6. Profit – earnings before interest, taxes, devaluation and amortisation (EBITDA) Practice gross minus practice costs (before owner draws income, personal costs and personal tax).

I am always worried that when we start talking about KPIs it begins to sound overwhelming. So always suggest that you start with those that make sense to you. Collate them weekly and then do a monthly sheet. Maybe just start with gross turnover, % recalls (dentist and hygienist), number of new patients, number of cancellations, number of FTA's. But use the sheet monthly and once you start sharing the information teams start to respond.

August 2015

PERFORMANCE MANAGEMENT

·       Key Performance Indicators are a sub-set of the overall process of performance management.

·       A business will have a vision underpinned by a business plan. One of the outputs of the business planning process will be how the business and every individual in it is measured, and part of this measurement system is the KPIs.

KEY PERFORMANCE INDICATORS

·       As a manager you will need to be able to manage the performance of your team in terms of quality and quantity of output. The things you measure to ascertain the level of your team’s performance are called performance indicators. The main indicators of performance are called key performance indicators (KPIs).

·       There are two types of performance indicators you can use – lead and lag.

·       Lead performance indicators relate to lead-activities that, if they happen will lead to the desired output or end result.

·       Lag performance indicators relate to outputs or results themselves.

·       Most organisations are good at identifying lag indicators but not so good at identifying lead indicators.

·       A lag indicator will tell you whether or not you achieved the desired output or end result AFTER the event happened.

·       A lead indicator will tell you whether or not you are likely to achieve the resultBEFORE it happens, enabling a manager to take corrective action before it is too late.

LEAD Performance Indicators

·       The number of hours a year staff attend off-the-job training.

·       The number of formal one to one coaching sessions conducted on the job per employee per year.

·       The number of staff grievances identified and addressed each six months.

·       The percentage of actions implemented from those agreed during team meetings throughout the year.

·       The number of times each year that performance standards are clarified, agreed and reviewed with the team.

·       The number of times per year that we clarify and agree individual and team priorities.

Key performance indicators are used to indicate whether a person is performing the key activities that make up the key results areas for their job. These are the activities which, if performed, should lead to the desired result. Once you have agreed the key results areas with your staff the next step is to define the key performance indicators for each key results area.

Key results areas normally have one to three performance indicators.

There are two ways to determine key performance indicators:

1>if a person was doing this KRA well or doing it successfully what would you see happening?

2>if a person was not doing this KRA well or doing it unsuccessfully what would you see happening or what would not be happening?

Performance indicators usually meet the following criteria

·       They are measurable factors against which goals may be set

·       They may represent:

o   ‘hard’ numbers e.g. units of production per hour

§  number of new customers per month

§  amount of idle hours

o   problems to be overcome

§  interpreting changes to pricing policy

o   ‘soft’ numbers or indicators of effectiveness in a subject area e.g. staff turnover, absenteeism related to staff morale

·       they usually only identify what will be measured not how much e.g. rework as a percentage of total effort not 10% reduction in rework

·       there are three types in descending order of use

o   concurrent indicators – factors that can be identified in advance and tracked during performance against objectives

o   pre-indicators – factors identified before the fact that will point to a course of action – economic trends, new competition

o   terminal indicators –factors that can only be measured after the fact e.g. project completion

·       the cost of identifying and monitoring them will not exceed the value of the information

Q.I’m currently looking at what we pay out for things at the practice and looking at any possible savings to be made. I am confused about how often autoclaves have to be serviced. I hear different things from the company that carries them out to what other managers have said. I feel like a lot of companies out there want to get your business as often as possible.

Also, are pressure System vessels to be checked annually. I’ve also heard different things for that too!!

A.The HTM01-05 stipulates time frames for servicing and validating pressure vessels BUT the deciding factor is what is recommended by the manufacturer of the autoclave or compressor as this super-seeds the HTM01-05.  We rent Burtons Autoclaves as their service is excellent and the company is just down the road from us.  We have our machines serviced every 6 months and validated once a year.  When we used to have SES machines we still had to have them serviced twice a year.

Both insurance companies that we have used (Towergate & Lloyd & Whyte) both require an inspection of our pressure vessels by a qualified, registered engineer and they charge a set amount for this to be carried out all within the cost of our insurance package.  I have just renewed our insurance with Lloyd & Whyte and they have said this year because we have BDA Good Practice membership, Denplan Excel and have a validation certificate for the machines they will not require a site visit from an inspector.  If you have these accreditations it may be worth asking  your insurance company?

A.We should follow the guidelines stated in HTM01-05 and this states we should follow manufacturer's instructions.

From past experiences this is normally 2 services annually.  

If autoclaves need upgrading it may be worth considering a lease option Prestige Medical offer a very good packages. (We found this very cost effective)

Pressure Vessel check Inspection Report should state when the next examination is required.

A.These questions are dependent on the recommendation for the manufactures guide for autoclave, we have ours done annually with full validation, but also have a service contract for any intermediate repairs.

The pressure vessels, include autoclaves and compressors, again I have our compressor checked annually, and every other year the compressor has also to be checked internally, again this is also dependent on the pressure vessel insurance you carry.

A.Eschmann used to do  3 a year for service, but have recently changed depending on cycle usage, which means for us twice a year BUT still charge us the same annual amount.  I tried to get this reduced but to no avail L Our certification is every 14 months.

September 2015

Q.Do you have a lift in your practice and what are the health and safety implications, restrictions and responsibilities in having one.

A.We have a chair lift which is subject to 6 monthly maintenance/servicing and annual certificate of inspection

Health & Safety – you have to ensure your fire evacuation is clear in terms of not using in the event of a fire.

You also need to ensure that chair lift is supervised by a trained team member when it is operated (bit different for lifts I would think).

September 2015

Q.Can anyone provide advice regarding film testing and/or phosphor plate testing for OPG/3d scanner?  We have recently had one installed and are under the impression we need to do a step wedge test.  I would welcome help with this as to what others do, and use and where you obtain the test equipment from.

A. We purchased the stepped wedge test from our supplier below.  We find them very helpful with any queries we may have also.  Hope this helps.

DBG (UK) Limited t/a The DBG (Dental Buying Group)
Norfolk House
Bostock Road
Winsford
Cheshire
CW7 3BD

Q.Can anyone provide advice regarding film testing and/or phosphor plate testing for OPG/3d scanner.  We have recently had one installed and are under the impression we need to do a step wedge test.  I would welcome help with this as to what others do, and use and where you obtain the test equipment from.

A.This is an issue which you need discuss with your RPA and record the RPA's advice in your Radiation Protection file.  These things all need to be formalised.

August 2015

Drugs and equipment required for a medical emergency

Our priority is to carry out an assessment of the quality of primary care dental services. From this we make a judgement about whether they provide people with care that is safe, effective, caring, responsive and well-led, based on whether the regulations (including the fundamental standards) are being met.

Our inspectors will consider this topic of drugs and equipment for a medical emergency when they review if the practice is safe which relates to regulation 12 (safety of care and treatment).

The medicines and equipment should be in an accessible and central location known to everyone.

Mandatory requirements

The GDC standards for the dental team state that, as a dental professional, you must follow the guidance on medical emergencies and training updates issued by the Resuscitation Council (UK).

Whilst there is no mandatory requirement for the equipment below, a practice could be in a difficult position from a medico-legal point of view if a patient came to harm during dental treatment due to the lack of emergency medicines and equipment listed under 'recommended practice'.

Recommended practice

Professional guidelines: British National Formulary

1. To manage the more common medical emergencies encountered in general dental practice the following drugs should be available:
   • adrenaline injection (1:1000, 1mg/ml)
   • aspirin dispersible (300mg)
   • Glucagon injection 1mg
   • Glyceryl trinitrate (GTN) spray (400micrograms / dose)
   • Midazolam Oromucosal Solution, midazolam 5mg/ml
   • oral glucose solution / tablets / gel / powder
   • oxygen
   • Salbutamol aerosol inhaler (100micrograms / actuation)

Professional guidelines: Resuscitation UK Guidelines November 2013: Minimum equipment list for cardiopulmonary resuscitation in Primary Dental Care

1. The following is the minimum equipment recommended:
   • adhesive defibrillator pads
   • automated external defibrillator (AED)
   • clear face masks for self-inflating bag (sizes 0,1,2,3,4)
   • oropharyngeal airways sizes 0,1,2,3,4
   • oxygen cylinder (CD size)
   • oxygen masks with reservoir
   • oxygen tubing
   • pocket mask with oxygen port
   • portable suction e.g. Yankauer
   • protective equipment – gloves, aprons, eye protection
   • razor
   • scissors
   • self-inflating bag with reservoir (adult)
   • self-inflating bag with reservoir (child)
2. Oxygen cylinders should be of sufficient size to be easily portable but also allow for adequate flow rates, eg, 15 litres per minute, until the arrival of an ambulance or the patient fully recovers. A full ‘D’ size cylinder contains 340 litres of oxygen and should allow a flow rate of 15 litres per minute for approximately 20 minutes.
3. Quality Assurance Process: Expiry dates for emergency medicines and equipment and availability of oxygen should be checked at least weekly.

Q.Does the water in the cleaning bowl, rinse bowl and the ultrasonic bath need to be below 45 degrees centigrade?

If so, why?

Do you keep a thermometer to ensure that the water temperatures are below 45 degrees in your decontamination room?

A.Yes we use a thermometer to make sure the water is less than 45 degrees, this is to stop protein from coagulating onto mental instruments as they will not sterilise in the autoclave effectively.

A.Yes According to htm 01-05 you are supposed to have either 45 degrees or lower than that.  A higher temperature will coagulate protein and inhibit its removal.

A.Yes it does.

If you look at the HTM01-05 document it mentions it. When it talks about manual cleaning the reason is that research has shown prions are potentially more likely to stick to the surface of an instrument if they are washed / rinsed in temperatures of 45 degrees or above.  Once the prions are “baked on” it is almost impossible to get them off.

It is not acceptable to just wash/rinse in cold water as you have no proof that you are within the temperature parameters.  Thermometers are cheap and readily available on-line.

November 2015

Dental Team Vaccine Department of Health Guidelines

The Department of Health guidelines recommend that clinical members of the dental team should be up to date with the following vaccines: 

·       Hepatitis B (HBV) vaccine (antibody titres for hepatitis B should be checked one to four months after the completion of a primary course of vaccine).

·       Measles Mumps and Rubella (MMR) vaccine (unless documentation is provided of having received two doses of MMR or having had positive antibody tests for measles and rubella).

·       Chickenpox vaccine if non-immune (protects against chicken pox and shingles).

·       BGC vaccine (protects against TB – immunity tested with Mantoux test).

·       Tetanus, polio, diphtheria (routine vaccinations).

·       Seasonal Flu (annual vaccine)

Non clinical staff such as receptionists and cleaners should be up to date with the following vaccines: 

·       Tetanus, diphtheria, polio, MMR (routine vaccinations).

·       Hepatitis B (a requirement for staff who come into contact with body fluids and blood during their work or there is a risk from sharps injury or splashes such as handling clinical waste).

– See more at: https://www.isopharm.co.uk/dental/immunisation#sthash.2LccxM5g.dpuf