Covid-19

Introduction

Due to the escalation of Covid 19, leading to a partial lockdown of services nationally. A letter was issued on 25/03/20 by COO Sara Hurley with details of changes to primary care dental services ( appendix 1).

Opening hours

Practice opening hours will remain normal 9-5 Monday to Friday for NHS patients and the out of hours advice service for den plan patients will run as normal. The practice door will be locked and a phone advise service run to triage patients to the most appropriate treatment. This provides a remote urgent care service as per the CDO's advice

Routine Treatment

All patients for routine treatment will be contacted to cancel their appointments.

Telephone triage

Between 9-5 reception and nursing staff will answer phone calls from patients. All phone calls are recorded on audit sheets (see appendix 2). Recording patient details, presenting complaint and action taken. This is reviewed by the dentist on duty that day and any patient they feel action is required will be contacted that same day.

Phone staff triaging will follow the advice sheet in appendix 3, if the sheet indicates a dentist's advice is needed the call will be forwarded to the dentist on duty that day.

Patients are informed that we are unable to provide routine, non urgent dental care. Details of patients request are logged and an appointment arranged for after the pandemic

Patient Treatment

Following telephone triaging the dentist on duty will make an assessment of the dental condition.

Advice if appropriate will be given on the phone, appropriate analgesia will be discussed . If the dentist diagnoses infection over the phone appropriate antimicrobials will be prescribed.

An agreement has been set up with Natasha Klein senior pharmacist at Rowland Pharmacy, Parkgate, Knutsford. Prescriptions will be emailed over with patient details and prescription copied to Natasha.kelin@nhs.net the hard copy of the prescription will be delivered to the pharmacy with 72 hours.

If a patients condition cannot be manages by analgesics and antimicrobials they will be the appropriate Local Urgent Dental Care System.

Currently there are no Urgent Care Centres of systems in operation therefore the following procedure will take place:

  • If it is deemed appropriate by Guy Ward the patient will be assessed to check for symptoms of covid-19 on the phone- fever, cough, shortness of breath. It will also be checked no one they have been in direct contact with is symptomatic or has a positive test, Positive or symptomatic patients will be asked to call 111

  • They will be asked to attend the practice, waiting down stairs in a parked car and phone the surgery when they arrive.

  • The patient is then advised to come into the practice when they are shown directly to the surgery 1 by nurse wearing appropriate PPE

  • Appropriate PPE is FFP3 mask, goggles, visor, surgical gown and hair net, gloveThe treatment given will not involve generation of aerosols i.e., high speed, slow speed, ultrasonic, 3 in 1 syringe.

  • The surgery will be deep cleaned directly after the patient leaves and 40 minutes after that again. Cleaning will take place wearing PPE.

Protecting Staff

It is of upmost importance to Mobberley Road Dental Practice to protect our staff, the following measures will be taken:

  • Staff will work in 2 teams Monday -Tuesday and Wednesday-Friday to ensure that if one team member gets COVID 19 the whole team are not affected.

  • If a staff member or member of household get fever, cough or shortness of breath they will self isolate for 7 days before return to work

  • Covid 19 testing is provided by the practice to ensure staff safety

  • PPE for treating patients consists of FFP3 mask, surgical gown and hat, gloves, goggles, visor

Management of Covid-19

  • Staff members are aware of where to find latest guidance for management and prevention of Covid19 relevant to dentistry.

  • Appropriate signage and posters are on display for all staff, patients and visitors regarding social distancing, use of PPE, access to hand sanitiser etc.

  • All staff are adhering to social distancing (2 metres) wherever possible, particularly if not wearing PPE and in non-clinical areas, such as during work breaks and when in communal areas.

  • All non-essential items including toys, books and magazines have been removed from reception and waiting areas, surgeries.

  • A risk assessment has been completed to identify which treatments are aerosol generating procedures (AGP's) in line with the dental standard operation procedure guidance (SOP).

  • Staff are aware of what level of PPE should be used by all staff groups in the dental practice.

  • Fluid repellent surgical masks are being used on a sessional basis but other PPE such as aprons and gloves are single patient use. Risk assessments are being completed for the use of Eye protection such as visors/goggles. All PPE is being disposed of as clinical waste.

  • All staff are aware of the correct donning and doffing of PPE procedures to be used. Donning and doffing signage is on display for staff.

  • Enhanced hand hygiene procedures in place which include washing up to elbow, compliance with the 5 moments for hand hygiene, bare below the elbows procedures.

  • Cleaning is being performed using a neutral detergent, followed by a chlorine-based disinfectant, in the form of a solution at a minimum strength of 1,000ppm available chlorine.

  • Uniforms are being laundered separately from other household laundry at the maximum temperature the fabric can tolerate and then tumble dried or ironed. There are appropriate stations for donning & doffing of PPE.

  • Additional precautions are in place re: segregation of patients for example, who are clinically extremely vulnerable {previously advised to shield) may be seen for dental care in the same way as other patients.

  • Patients are triaged by phone or teleconference. Where possible asked to wait in transport vehicle before being called in.