GDA Action October 2021

32 • October 2021 leaves the building, or done within 24 hours, depending on the facility’s policy and guidelines. Medicines (Written and/or Called in; Pre-Op or Post-Op) We don’t always know how much pain or bleeding there will be, nor how difficult the extractions may be, or even how many teeth we are removing. Often these are determined after the patient is asleep and we do an oral exam plus X-rays. We cannot easily chitchat with the family from inside the OR, so all of this plus contingencies must be planned. There is significant trust that we will accommodate the family’s wishes and reasonable expectations. So, we have a prescription pad as well as the pharmacy phone number to call in whatever we feel is necessary. Sometimes the prescriptions are filled in advance of the OR date. When the exact treatment to be performed is less predictable, we prefer to call in the Rx after case completion so it can be ready and picked up on their way home. Gauze, Ice Packs In our office, for patients with a normal gag reflex, we provide a 2x2 inch gauze square or other cotton products to control the bleeding after any periodontal or oral surgery. If the patient is asleep, there is no gag reflex, and a chance that the cotton product will end up in the lungs. To prevent this potentially life-threatening emergency, we do not leave any cotton or anything loose in the mouth. Instead, we give the family gauze to be used later when the gag reflex had fully recovered, or advise them to use similarly shaped tea bags for hemostasis. The facility provides ice packs, often with string ties similar to face masks that can keep the ice in place to help slow the bleeding. The patients are also given disposable kidney shaped emesis basins to allow blood trickle into the plastic bowl. Written Instructions Like most offices, we have written post-operative instructions for most of our common procedures performed in our office. The procedures are the same whether performed in our office, OR, or elsewhere. My staff always includes copies of all possible procedures that might be performed on that patient in the OR on that date. At the end of the case, we review and give those instruction sheets to the accompanying family or caregivers. Additionally, when we know what types of procedures we will perform, we give those instruction sheets to the family so they can be reading them while we are in the OR, then merely review the relevant items after the case is completed. We never expect anyone to remember everything we said. Everything is in writing, including our after-hours phone numbers.  Following Discharge from the PACU (Post Anesthesia Care Unit) Immediate and Next-Day Instructions Post-op information for the people bringing the patient home must include both the dental, plus the general anesthesia instructions. Both we and the facility nursing staff remind the family that the patient may be nauseous, sleepy, and wobbly for the rest of the day. Normal activities generally may resume the following day, with the additional admonitions of managing any precautions in the mouth. This includes being mindful of extractions sockets, temporary crowns, high restorations, immediate appliances placed in the mouth, suture management, and more. Follow-up appointment information We always provide a follow-up appointment. We may have to remove sutures, check extraction sockets, adjust a delivered appliance, deliver a new crown or appliance, reduce a high filling, modify a temporary crown, take an impression, or even check the occlusion with articulating paper. There are many reasons for at least one follow-up visit. Hospital vs Surgical Center I have worked, and still work, in both conventional hospitals and free standing surgical centers. Each have their pros and cons. I appreciate the availability of other medical professionals in a hospital setting. I especially value the opportunity to co-operate (that is two Drs. operating together) on a case. In hundreds of my dental cases, we invited another health professional to come to our OR at the beginning or end of our case to perform a colonoscopy, pap and pelvic exam, clean their ears, biopsy another part of the body, trim their toenails, obtain non- dental X-rays, or even draw blood on uncooperative patients. I cannot imagine a better two-fer than having multiple necessary procedures while asleep. On the other hand, the turnover time in a hospital is generally longer due to the larger number of beds, staff and OR’s This includes being bumped by another doctor needing my elective case OR for an aneurism, accident or some other medical emergency situation where we find ourselves waiting until the more urgent case is completed, and the OR is turned over for the next case. In surgical centers, we do not compete with other doctors who have prioritizing emergencies, so they run more efficiently. But if a medical issue arises, there may be no other doctor in the building except the anesthesiologist or nurse anesthetist. Some surgical centers are limited to only IV MAC (monitored anesthesia care), while larger facilities offer full out-patient general anesthesia. Each facility has its advantage, and all are essential in the available offerings to our patients.  Paperwork Transitioning to EMR If you have not made the switch to Electronic Medical Records, get ready. Most doctors agree it is one step backward to go three steps forward. It is necessary and it is here, now. Before: There is always pre-op paperwork. The patient needs to provide a previous History & Physical so the anesthesia team can confirm that the case is appropriate ANXIETY OR SPECIAL NEEDS Continued from page 31 14-Dr. Joe Bee with a patient at nursing home 15-Nursing home patient thanks hygienist