GDA Action October 2021

October 2021 • 33 for their facility and to determine if any additional precautions or consults are required. The patient must be informed of Pre-Admission Tests (PATs) which generally include at least a blood test, sometimes a urine test, a negative pregnancy confirmation, and currently also a negative COVID-19 test. Consents must be signed for the dental procedures, as well as for anesthesia. Insurance and financial arrangements are needed to avoid surprises later. In the pre-op area, all paperwork is confirmed, especially an H&P from the physician within the last 30 days saying it is okay to proceed with the case under general anesthesia. The nurse confirms that the patient did not eat solids other than medicine for the past 8 hours, and that all consents are properly signed. During: In the OR, the dentist or hygienist announces everything that he or she is doing, including the times of throat pack insertion and withdrawal. A non- scrubbed dental assistant or other health professional takes notes so these can later be incorporated into the operative report plus dental chart for documentation and billing. After: As soon as the case is completed, brief notes are recorded in the facility’s documentation system. Discharge orders, Rx’s and additional operation details are required either before or after speaking with the patient’s accompanying family or caregiver. This may be written and/or dictated, but is a requirement.  Legal Issues Informed Consents Proper informed consents are necessary for all concerned. It lets the patient and his/her team know what is planned and what is authorized. Whatever is not included is excluded. Sometimes, with no good pre-op exam or X-rays, we do not have a well-defined plan. So, keep the consent flexible by writing and agreeing to: possible periodontal scaling, possible restorations, possible root canals, possible extractions. Do not write down the tooth number or letter, or precisely how many teeth are to be removed or restored. If you wrote down “extract tooth #3” you may not extract tooth #2, even if you or your staff made a clerical error. If you wrote extract two teeth and discover a third non-restorable tooth, you jeopardize your license if you take out that third tooth or anything not explicitly and specifically written on the sheet. So keep it flexible by writing the words “multiple teeth” rather than any specific tooth number, letter, or quantity. Present and Explain the Options Giving a patient or their responsible party a printed sheet of paper and asking them to merely sign it is not good enough. They may or may not understand what they are signing. You must not assume they do. At the very least you are required to summarize what is on the sheet so it can be considered an “informed” consent and not a blindfolded or misunderstood consent. Our policy is to gather the data, assess both subjective and objective, then present multiple options. For years, hospitals have been using SOAP notes for every patient. That is subjective, objective, assessment, and plan. That is similar to my verbal consultation protocol of presenting the facts, offering my opinion, then stepping back as the patient and his/ her team decide what is best for them. I will never knowingly do something wrong, but I will perform my third choice treatment plan if it happens to be the patient’s first choice. I will, however, have them sign off in writing that they rejected the alternate plans that I recommended. I will extract a tooth if the patient rejects a root canal. Similarly, I will do my best to save a questionable tooth if that is 16-Bedside extraction 17-Guatemala special needs clinic waiting room 19-Guatemala dental students assist Dr. Levy on difficult extractions 21- Eastman Institute Oral Health Smile Mobile 22-Dr. Diane Romaine at MDMission of Mercy 18-UTSA volunteers team up with students on Dr. Jeff Hicks’ Guatemala special needs mission 20-Eastman Institute Oral Health Smile Mobile »