Work Experience DPL

Can I accept a request for work experience from a school pupil who is interested in a career in dentistry?

24 March 2015

It is not unusual to receive a request for work experience from a school pupil. Observing in a dental practice can enhance the pupil’s understanding of dentistry and can assist them in deciding whether or not dentistry is the career for them. Not only that, but some dental schools prefer applicants to have undertaken some type of relevant work experience.

So what does a practice owner have to consider before agreeing to such a request?

Health and safety

Under health and safety law, a work experience student is considered to be your employee. You treat them no differently to other young people you employ. A young person is defined as anyone under the age of 18.

As an employer you will already have carried out a risk assessment. Under Health and Safety law you must assess the risks to young people under the age of 18 before they start work experience and tell them what the risks are. Young workers may be particularly at risk from work place hazards because of their lack of awareness of existing potential risks, immaturity or inexperience.

Health and Safety legislation addresses the protection of young persons at work in detail, and you should consider your obligations in this regard. The Health and Safety Executive guide, Young people and work experience: A brief guide to health and safety for employers, contains helpful information about these obligations.

Assess the risk

Before the young person can start work experience, the practice owner must carry out a risk assessment to identify any specific risks which they might face. The assessment must take into account the following:

• The inexperience and immaturity of young persons.
• Their lack of awareness of risks to their health and safety.
• The fitting and layout of the practice and surgery.
• The nature, degree and duration of any exposure to biological, chemical or physical agents.
• The form, range, use and handling of work equipment.
• The way in which processes and activities are organised.
• Any health and safety training given.

You should keep a record of the main findings of the risk assessment. This is good practice and it is a legal requirement if you have five or more employees (including young people on work experience). The risk assessment and any control measures taken should be shared with the parents of the work experience student. See the Health and Safety Executive’s FAQs for more information.

Once the young person is ready to commence their work experience it is important that you check that they have undergone and understood training which covers, for example:

• The hazards and risks in the work place.
• The control measures put in place to protect their health and safety.
• A basic introduction to Health and Safety, for example, first aid and fire and evacuation procedures.

In addition to this you may wish to check that your employer’s liability insurance and public liability insurance cover includes work experience students.

Confidentiality

Confidentiality is crucial and a clear induction is of paramount importance, as is the need to check the young person understanding of the subject. Confidentiality extends not only to the patient’s treatment, but also to the fact that someone is a patient of the practice. This might include some of the young person’s peers or teachers!

Issues of confidentiality also extend to access to the dental records and to the appointment book and you would need to ensure that the student is fully aware of your confidentiality protocols.

It would certainly be appropriate to check with each individual patient that they are happy to have a work experience student observing their dental treatment, and to emphasise that the patient can change their mind at any time.

The Working Time Regulations 1998 apply to work experience students and you may wish to consult with the school concerning the hours which they wish the work experience student to attend your dental practice.

Can I have a go?

The days of work experience students mixing materials and assisting at the chairside are long gone! It is appropriate to manage the work experience student’s expectations so that they are fully aware of that their experience, whilst being very worthwhile, will be limited to observing.

Dental Protection 2015

Q. I have just condemned my DAC autoclave to the great decontamination suite in the sky and need a replacement. What could you recommend? I don't want another DAC, it was temperamental and broke down a lot but I think it was the only machine that lubricated and sterilised. Please let me know if you have a happy relationship with your hand piece decontamination equipment and what make it is.

A. We have had DAC's for a number of years. The old ones broke down a lot we even had the inside replace at the factory.

We could not find anything similar on the market. We purchased the newer version

2 years ago and it has been serviced twice and have not had any problems with it.

I think the fact that it has been serviced by a DAC trained engineer has helped greatly.

A. This is the hand piece steriliser I was recommended. 

The Assistina 3 x 3 by W&H. I bought from Henry Schein but I'm sure DD sell it too.

Feb 2014

Q.Who organises the DBS checks for the dentists and hygienists working at your practices? Do any of your dentists and/or hygienists use the update service? If so, do they set themselves up for this?

A.We use website, disclosure barring services and they have an online account where you credit the payment for an enhanced CRB and then your staff complete it at their own pace and at home themselves. They set up their own account although you can monitor.

You get results within a few days. Very efficient and easy to use.

We use them all them time or when needed.

A.I organise ALL of our 27 staff’s DBA checks

I use a company called Exess Ltd

They send you through the DBS forms (which you can choose on the form Standard or Enhanced)

You gather and check the staffs ID, i.e. passport, driving licence, utility bills and send a copy along with the DBS form to Excess

And they process and return

It is quick, efficient and we have used them for the past 4 years – with NO problems

A.We use Mencap, they are efficient, it’s all online easily trackable, would thoroughly recommend …£65,00 ish

August 2015

Q.We are looking into getting a washer/disinfector. I was told that we need a water softener as we have hard water in the area. As our decon room is not large enough we need to house the softener in another part of the building.  What this means is that ALL the water coming into the building goes through the water softener, and I am thinking is this necessary? Do I need soft water for the toilet flush? My concern is that larger volume of water will need extra salt and hence extra storage space will be needed. Also we would have to purchase a higher capacity softener which would be more expensive and will have the associated higher running cost.  

A.We have a w/d as well. We do not have a water softener. We use salt. This is in the instruction on how to use the W/D.

At first I purchased the salt from Eschmann. It was too expensive. Now I get the salt pellets from cash/carry. A bag is probably about £10 to £15.

August 2015

Q.I have been asked to create a policy/document for visiting tradesmen to the practice covering data protection? E.g.  IT consultant, the plumber, lab tec, etc. Does anyone have such a document they could forward me to help?

A.We have a visitor’s book that all tradesman sign in and out.  It has the date, time (in & out), company name and purpose of visit. At the front of the book we have printed – principals of confidentiality, data protection, code of practice, disclosure to third parties and practice rules, available for the tradesman to read.

A.You should have a contractor’s policy in place as they have to be aware of the practice H&S policy as you do of theirs 

*A third party confidentiality agreement template can be found in the template section

August 2015

Q.Our NHS contract is a fair size one. Would anyone have a spreadsheet or some form of keeping a running count of how many UDAs are completed by each associate, how many remain from target etc. Yearly target percentage? Basically keeping track of UDA targets for the whole year is what I am looking for. I really struggle with this so your help would be a life saver.

A. We use a dental package called Ismile and this does it all for us. Otherwise if you access the principles NHS portal you can get all the information from that.

A. I understand your frustration…it's taken me a couple of years to perfect, (but I managed to control my uda's last year to within 0.04% of its target??yeh!)  But I have a spreadsheet set up that I transfer the number of uda's sent in each claim package and then cross check what the BSA say I've done… That way I know if any claims go astray and what each dentist is achieving month by month. Do you use R4 or SOE software packages? If you do have either of these then I know that have the information you are after already installed within their program. You just need to tell their help desk to talk you through how to get at it.
 

August 2015

Q.I am recruiting a new registered nurse and would like to offer the short listed candidates a 'trial shift' I've never done this before. How would I pay a candidate for their time? Do they need to be on the payroll?

A.We have had a couple in the past and paid them for their time out of Petty Cash

We pay the same rate we would as if we were going to employ them, so whatever you are offering

A.This was also new to me with the Practice I joined a year ago, but all we do is offer a 1/2 day to observe and see what the job entails and have a chat after to see if they are still keen, we then say to them that we have another candidate for a trial and we will be in touch soon, but we do not pay them, we have done this for a receptionist, nurse, Hyg and not getting paid has never been an issue.

A.We offer this type of taster session for both our dental and orthodontic recruitment but we don't pay. We take it as a sign of mutual interest and have never had an issue with someone wanting to be paid. 

A.We do currently do this with all new employees, although do not offer pay, instead if the candidate is successful, we will give time back in lieu. I suppose it depends on how long the shift is really.

November 2015

Q.Does anyone know where we can get information on how to obtain a translator for a Romanian patient? I have contacted NHS England and they have told us we have to find our own interpreter and then they will reimburse costs.

A.We use CITAS interpreting services 

A.Languageline. It's a telephone interpretor service.

A.We’re in Sheffield & have used SCAIS interpreter service on 0845 124 8889.

A.info@essexinterpreting.com  or www.essexinterpreting.com

A. We use The Big word. Www.thebigword.comand they are excellent. 

A.Try Google translate app

A.I have a number for an interpreter = 0808 802 0202.  I have not used it in a while, so you need to check it is still valid.

A.We just Googled translation services in whichever is your local area, although we have never used this service you should have the detail available at reception as when cqc visit this could be a question they ask your reception staff, so all need to be aware of what to do and where to access.

A.Not sure if any help as we are in North Devon and it is several years since we used this service but I have attached the details.  We used them for a patient who was having sedation with us and they were very good. (Communications Support Guide for Patients can be found in the downloads section)

A.Depending on where your  practice is, there are a few organization in Cambridgeshire, try KnockHundred Translations 01544 388040 they may be able to help you.

A.This is who we use, we registered with them and they send you all the info and your access code.

It's free of charge as far as I'm aware.

A. Interpreter Services Can help with translation and interpreter services.

We can call them direct and they will invoice the Area Team if we use the service if it is for an NHS patient.

For a private patient the patient or the practice has to cover the costs.

Language Solutions Line 08001692879

Milton Keynes Council Community Language Services 01908253253

Signs in Vision (Sign Language Services) 077285792789

A. We have had issues involving translating and I have spoken to the company below. They can charge per minute! The name is language line.

May 2015

Q.We have a trainee dental nurse starting at the practice, I’ve spoken with our principal dentist indemnity providers regarding her cover, they have advised that she will not be covered under his supervision/policy and they do not provide indemnity for trainees.

I spoke with GDC and they have advised me that the practice needs to provide indemnity cover for the trainee but the indemnity providers are refusing to do this.

Has anyone experienced this problem or what indemnity providers do you use that cover your trainee staff?

A.I am sure that ALL trainees are covered under Medical Defence and Dental Defence

A.We have 3 partners at the practice, two of them are with Dental Protection and one with MUD.

Dental Protection will add the qualified nurses to their policies and we to have trainee nurses that have been added but they have said because they are not qualified and are working under supervision they are not fully covered but added for advice only. They are due to follow up with an email explaining what this actually means, which I can send you when we receive it.

I suppose the next port of call would be advice from the college the trainee is attending.

It seems strange that the GDC are saying they do need indemnity if they are not the GDC register as yet.

A.If the trainee isn't GDC registered they don't have to have indemnity, but the supervising registrant must, as they are responsible for the students work. This is stated on GDC website on section on employing trainees! 

A.We take our trainees from our local university and they are covered from their course provider.

A.We have had trainees for years and never come across this.

Provided they are in an accredited approved training course and you have liability insurance then that’s all the training provider checks. 

I would suggest you check with the training company what insurance should be in place, as i say never had a problem, they can nurse as on course.

A.I believe that in situations of this nature, the individual must purchase her own indemnity cover, which is what associates and hygienists must do.  Hope this helps.  Can be expensive for a trainee.

October 2015

Q.I wonder if anyone can help – some of our nurses are complaining about the temperature in the decontamination room at work.  It reached 28 degrees yesterday.  HTM0105 guidance suggests that best practice means no fans or open windows or air conditioning.  I wonder how other practices get around this issue.

A.I believe you can have air con or a fan as long as the air flow is in a 'dirty to clean' flow direction or even avoids that area at all.  We had an air con unit in our sterilisation area which was positioned in a way that the air flow was not going against the dirty to clean work flow and we never had any problems from our CQC or infection control advisors check.

A.I spoke to a Health and Safety at Peninsula Law Firm this morning and he said that although best practice (from an infection control point of view) would state no air conditioning, doors and windows closed and no fans, the risk is very minimal and the far greater risk is to staff working in the room.  The advice I was given was to fit air conditioning but ensure it was well maintained, all records were kept and it was serviced annually.  Having looked at HTM0105 I believe that the advice Natasha has given above, further makes this the best option.

A.We do have the window open but have had a special mesh fitted so nothing can get into the room, and we do have a fan in there.

A.We have experienced the same problem over the last few weeks…we have a dedicated Decon Technician who is currently covering some maternity too and therefore in for 5 full days, servicing 6 surgeries. It has not been pleasant for her.  

We had a guy service all our air con units last week and so we asked his advice. There is a type of unit that is compliant, and he has promised to send me more info. He did mention that it was extremely expensive though, for what would probably just be used during a couple of months per year. I will forward more info when I have it.

A.We had special air con installed by ‘ACRS of Evesham’ when we refitted our long, thin-shaped decon room – it inputs clean cool air at the ‘clean’ end of the room and takes it out at the ‘dirty’ end, via circular ceiling fittings (look like ceiling lights). There is a huge aircon system that had to be installed in the roof space above! I don’t know if it would be classed as best practice, but the dental company doing the re-fit (Promec Ltd) recommended it.

July 2015

Q.Can anyone help with how they plan/organise their staff rotas?

We are currently experiencing a little unrest with our team particularly with some of the team not wanting to move or change who they work with.

Given that we have 9 surgeries and they vary between orthodontic and general, we plan 1 month in advance and also feel it’s good to change around to increase skills/experience.

Any help from others who plan and organise a team would be valuable.
 

A.I work with a smaller team but have recently been through this with changes to all rotas and who works with who.

Obviously it really helps to have the team on board with the plans – do they all understand why you want to make changes.

Also can you suggest a trial period with a meeting in say two to three months time to review how everyone thinks the changes are working out – this will probably make people more willing to give it a try in the first place and most likely they will find it is not as bad as they expected – no one likes change eh! Give them plenty of notice if you can with the new rota and aim to make it as fair as possible.

If all else fails – maybe an incentive or reward for those willing to try and change.

You can of course go down the contract route – are they contracted to one particular way of working, will the changes affect their contract? If No, then really they have to give it a go at yours or the principles say so. If their contracts would be affected then more negotiation may be needed.

I honestly think, just persuading people to try to changes with no permanent decisions to be made until a review is usually the best way to get folk on board with ideas and plans.

A.I had the same issue, there is no magic formula where we can please everyone.

At my last practice (in Portugal), I made each nurse responsible for a surgery and that was where they worked no matter who the clinician or specialist was. They were solely responsible for keeping their surgery clean and fully stocked. This seemed to work the best for me and for them.

Currently I am running three practices, and after some trial and error, I have decided to create practice teams, both for receptionists and nurses.

I met will all the team individually and asked if they had any rota suggestions, taken all of their input on board and agreeing on some compromises, the new rota came out. One week they might have to work with someone that is not their favourite, but then the following week I will ensure that they are with the specialty they enjoy the most. (We have all the specialists here, so the work is varied).

I have always done the rota on a weekly basis, but with this in place I think I can safely release a monthly one, with set teams in place and set shifts, it should prove easier to do and less time consuming. So far it seems to be running better than before, but only time will tell, I guess.

A.Yes you are right, but this is not easy to do. What I do in my practice,

One dentist—one room—one nurse

You have to find out which dentist/nurse combination can work, then plan.

A.It would be good to understand a little more about the unrest as I sense it's a little more complicated than just a rota issue.

But, I've recently come across RotaCloud.com and found it very useful in managing a rota across different sites. It allows the rota to be seen by who you would like and also allows all employees to submit requests. As its cloud based it's easy to access and for people like me that on occasions find the additional of more software a little burdensome has proven quite simple to use.

Please be assured that I have no other connection or interest in RotaCloud. I came across them as I was searching for a way of making rotas simpler to manage for one of my client's.
 

A.We arrange the rota on a weekly basis, each dentist has 2 or 3 nurses (we call them main nurses) they mainly work with and they all rotate between the dentists, hygienists and scrub duties, some do reception work as well, they get quite a variation but generally would have 2-3 days working with the same dentist. If I ever need a nurse to work elsewhere it wouldn't be questioned they would just get on with this, it is their job after all, perhaps remind them of that.

Q.I have a couple of queries regarding staff immunisations, first of all regarding BCG. Do we need to have blood test results showing that we have all been immunised or is it sufficient to have a record of who has had it and when. Secondly regarding tetanus, I believe that boosters should be had 10 yearly – is it necessary for everyone to have boosters purely for working purposes, i.e. do we need to go to our GPs and have this if it is more than 10 years since we last had it and again do we need to be able to provide proof?

A.Regarding immunisation, the guidance suggests that you nominate a person within the practice to co-ordinate staff health and keep a written confidential record of immunisation schedules and antibody test results. Permission (written consent) must be first gained from the team members before requesting any confidential information from their GP. Put in place markers or an alerting system to help the practice keep their records contemporary and ensure that all members of the dental team are up to date with booster vaccinations.

Regarding the BCG vaccine, the guidance states that this vaccine is recommended for healthcare workers who may have close contact with infectious patients. So therefore this vaccine should be given to all staff involved in direct patient care. However the BCG vaccine is not routinely recommended for non-clinical staff in healthcare settings.

Guidance states that all staff who are involved in direct patient care should be up to date with their routine immunisations including tetanus.

That being the case, the proof of immunisation required, will vary from practice to practice depending on what the Practice Owner feels is adequate.

If you have any further queries please do not hesitate to contact me.  

Kind regards

William Reynolds

Legal Assistant

LCF Law

November 2015

Q.Can anyone help please with a sample of a letter to NHS patients that continue to fail appointment?

We have a Policy to cancel appointments given us 24 hour notice

I am sure that many Practices have the same problem. I understand there some practices that send a letter advising such patients of de registration.

A.Letters FTA1 and FTA2 can be found in the template section of the website

A.We use a two tier system, the first appointment, then a letter is sent

Re       Failed Dental Appointment

We note from our dental records that you failed to attend or failed to give the practice 24 hours notice for cancellation of your dental appointment on:-

Please telephone the surgery within the next seven days to rebook this appointment, if we do not hear from you within this time, we will take it that you no longer wish to continue with your current course of treatment.

Please note that it is our practice policy that if you fail to attend or fail to give 24 hours notice on more than one occasion, this practice will no longer accept you as a patient.

If they fail again, we then send out this letter

It has been used in our practice for about 10 years, we have the off patient argue the case, but most patients are acceptable

Re:      Failed Dental Appointments

We note from our dental records that you have again failed to attend or failed to give the practice 24 hours notice for cancellation of your dental appointment on more than one occasion.

We write to advise you that as you have failed to attend or failed to give 24 hours notice on more than one occasion, this practice will no longer accept you as a patient.

A. Private and Confidential

MR D Test

Address ————–

04 Feb 2015                                                                                                                                              Our Ref:

Dear  ——-

This is to inform you that due to missed appointments at this practice, we are unable to provide you further treatment.

Practice policy and guidance from the local Primary Care Trust is clearly displayed in the waiting area and on appointment cards

If you wish to find another local dentist, please call the team of patient Advice Liaison Services (PALS) on 0800 3899 092 or 0208 3833 322

Alternatively, there is a list of local NHS dentist with letter.

Yours truly,

A.We use these 3 letters

1st

Dear

We see from our records that you failed to attend the practice for your

……………………………. appointment on ……………………………….

We hope that you are well and this was simply an oversight.

Surgery time was, however, booked for your appointment. If you are unable to attend an appointment, we ask that you give us at least 24 hours’ notice. Because we did not know that you would not be attending, we were unable to offer your surgery time to another patient.

In accordance with National Health Service policy, there is no charge for wasted surgery time. However under these guidelines, if you miss a second appointment, you may not be entitled to further treatment here.

If you have any queries, please do not hesitate to contact us.

Yours sincerely

2^nd (last chance)

Dear

We see from our records that you failed to attend the practice for your

……………………………. appointment on ……………………………….We hope that you are well and this was simply an oversight.

Surgery time was, however, booked for your appointment. If you are unable to attend an appointment, we ask that you give us at least 24 hours’ notice. Because we did not know that you would not be attending, we were unable to offer your surgery time to another patient.

As we informed you after your previous missed appointment, the National Health Service policy states that after two failed appointments, patients may not be entitled to further treatment. Your dentist is prepared to give you one more warning, but please be aware, if you miss another appointment your registration at this practice will be terminated.

If you have any queries, please do not hesitate to contact us.

Yours sincerely

3^rd  (Strick off letter)

Dear

We see from our records you failed to attend your ……………………. appointment on …………………………………….

You were informed after your last missed appointment that under National Health guidelines there is no charge for wasted surgery time. However, now you have missed a third appointment, you are no longer entitled to treatment at this practice.

Therefore, you can obtain a list of alternative dentists from the NHS Choices website at www.nhs.uk.

Yours sincerely

November 2015

Q. I’ve been asked my Principals to become our CQC Registered Manager (currently my boss holds this title!).

Are you able to give me a few pointers as to what the legal implications of this could be for me & any advice you may have as to whether I should accept/decline this role?

A.With regards to the legal implications of becoming a registered manager, please see our advice in this regard.

Registered Manager Regulations and legal implications

As a registered manager there is a particular regulation that you will need to abide by to satisfy your role. The specific regulation in relation to a registered manager is the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Regulation 7

The intention of this regulation is to ensure that people who use services have their needs met because the regulated activity is managed by an appropriate person.

Under Regulation 7 the registered manager must show that she:

·      Is of good character. This would mean demonstrating character traits such as honesty, trustworthiness, reliability and respectfulness.

·      Is able to properly perform tasks that are intrinsic to their role.

·      Has the necessary qualifications, competence, skills and experience to manage the regulated activity.

·      Has supplied them with documents that confirm their suitability.

It is important to note that the CQC cannot prosecute for a breach of this regulation. In place of this the CQC can take regulatory action. Regulatory action is action taken by the regulator of health and social care services in England to address a registered person’s breach of a regulation.

The CQC has an enforcement policy and can use various civil enforcement powers to improve care standards. These powers stretch to suspending the registration of a registered manager for a specified period. This is a rarely used power.

Another power is to cancel registration altogether which is one of the most powerful sanctions that the CQC have.

These powers will only be used where the CQC believe that the people receiving the regulated dental services have suffered harm because a regulated person is failing to comply with legal requirements.

Therefore to summarise, the CQC cannot prosecute for a breach of this regulation but there are regulatory measures that can be taken such as suspension and cancellation.

Kind regards

William Reynolds
Legal Assistant
LCF Law

November 2015

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