04 Sep 2018
By charlotte.cash
Tags: 
Domiciliary Care
Instrument Transportation

What Is Domiciliary Care?

Domiciliary care is a service provided that allows people to remain in their home, whilst still receiving assistance with their personal care needs.

The Dental Team & Correct Planning

If a dental practice offers domiciliary care services then a number of policies and procedures will need to be organised in order to ensure a smooth running and safe service for both staff and patients.

Similar to most dental services, it will require at least one dentist and one dental nurse to attend the appointment; however it may sometimes include an additional hygienist or therapist.

Where the service to be provided is predominately related to oral hygiene and dental disease, the team can be made up of one hygienist and one dental nurse, a dentist may not be required to attend.

No matter which team member attends the visit, each team member must be able to transfer their professional standards and skills to a non-clinical environment.

Mental capacity Act

When attending Domiciliary visit’s it is important that dental care professionals have a good understanding of the Mental Capacity Act (MCA), and are provided with Safeguarding training.

Decisions about the persons care and treatment are much more complex when the individual does not have the ability to make the decision for themselves. Dental care professionals (DCP) should always assume that a person has capacity unless it is established that they lack capacity. When a DCP is unsure if a person has capacity they should always follow the five principles of MCA.

There are five principles of MCA

 

Dental care professionals should always remember the individuals dignity and respect, and obtain the appropriate level of consent before proceeding with any treatment.

Further information on the mental capacity act can be found within our blog >

British Society for Disability and Oral Health

Guidelines for the Delivery of a Domiciliary Oral Healthcare Service

The acronym ‘CAMPING’ is used within British Society for Disability and Oral Health – Guidelines for the Delivery of a Domiciliary Oral Healthcare Service to highlight the key skills required to deliver an effective domiciliary oral healthcare service.

CAMPING stands for:

  • Communication
  • Assertiveness and anticipation
  • Manual handling and map reading
  • Planning and time management
  • Improvisation
  • Networking an liaison
  • Gerontology – knowledge of and experience in the field, including a knowledge of medical conditions, associated problems and management of medical emergencies

Preparation Prior To The Initial Visit

Preparation prior to the initial visit must take place. The practice should ensure the appropriate paperwork is in place, and that both the clinician and patient are aware of the process.

1. Telephone ahead to clarify the reason for attending. A telephone tick list may be helpful to ensure all areas are covered. This tick list may include:

  • Location address
  • Appointment confirmation
  • Medical history and consent
  • Parking facilities
  • Information on who will be present
  • Name of dentist visiting
  • Gaining access instructions

2. If telephone contact cannot be made, contact via writing i.e. letter/email. Include instructions on how the patient can make last minute contact with the dental care professional’s if required.

3. Health and Safety considerations:

  • Risk assessments*
  • Staff Protection
  • Chaperoning
  • Employer’s Liability
  • Personal Protection
  • Manual Handling Skills
  • Insurance for Vehicles and Equipment

*The CQC expect all dental practices to undertake a full risk assessment before carrying out treatment. This includes:

  • Any medical risks posed by the patients’ medical history
  • How suitable a person’s home is to carry out treatment

The British Society for Disability and Oral Health have also published a risk assessment template.

BSDH Domiciliary Guidelines click here >

Infection Control

During domiciliary care often dental care professionals will be working in a non-clinical area. However a clean work area should be maintained as far as reasonably practicable.

Clinical waste should be disposed of in accordance with local rules:

  • Sharps
  • Soft Clinical Waste
  • Medicines
  • Offensive or Hygiene Waste
  • Amalgam Waste
  • Plaster made from Gypsum
  • Domestic Waste
  • Extracted Teeth
  • Confidential Waste

All policies and procedures in the practice for control of infection will apply to domiciliary procedures in the same way as for clinic-based procedures.

Equipment & General Kit

The equipment and general kit to be selected for a domiciliary visit should be assessed based on the following:

  • Frequency of use
  • Types of treatment
  • Facilities available
  • Ease of adequate decontamination
  • Weight of equipment
  • Ease of transportation
  • Cost

Organising domiciliary kits into sub-kits is a great method to ensure everything required is in place, kept clean, fit for use and limiting the weight of kit for transportation.

British Society for Disability and Oral Health – Guidelines for the Delivery of a Domiciliary Oral Healthcare Service under appendix 9 offers a guide to the organisation of domiciliary kits into sub-kits. These are also listed below.

General Kit

  • Portable Light
  • Portable Suction
  • Examination instruments for initial assessment visits, eg mirror and probe
  • Finger guard
  • Infection control items and equipment
  • Gloves
  • Masks/face visors
  • Protective clothing for all clinical members
  • Plastic aprons
  • Sharps disposal
  • Alcohol gel
  • Plastic over-sheaths
  • Disinfection wipes
  • Waste bags
  • Paper towels, rolls, tissues
  • Dirty instrument transport box
  • Protective glasses for patient
  • Laerdal resuscitation pocket mask
  • Emergency equipment/drugs kit/oxygen

Oxygen should be transported in line with ‘Transporting Oxygen Cyclinders’ provided by the department of transport. Small quantities of medical gases are not currently covered under any specific regulations, however suppliers may recommend carrying a transport emergency card (TREM Card).

Administrative Items

  • Name badge
  • Diary
  • Appointment cards
  • Record cards
  • Referral forms
  • Laboratory forms
  • Post-op instruction leaflets
  • Consent forms
  • FP 17’s
  • Prescription pad
  • BNF
  • Mobile phone
  • Pen
  • A-Z route map/ Satellite Navigation System
  • Change for parking
  • Medical history forms
  • Health promotion literature
  • List of contact phone numbers

Prosthetics Kit

  • Impression material
  • Impression trays & mixing equipment
  • Safe air heater
  • Portable motor, handpieces, burs
  • Waxes
  • Pressure relief paste
  • Bit registration material
  • Wax knife
  • Bite gauge
  • Paint scraper/occlusal rim trimmer
  • Denture pots
  • Scalpel
  • Impression disinfection
  • Adhesive/fix
  • Shade guide
  • Articulation paper
  • Plastic bags
  • Gauze
  • Cotton wool rolls
  • Vaseline
  • Denture fixative
  • Dividers
  • Indelible pencil
  • Denture marking kits
  • Tissue conditioner
  • Impression disinfectant baths

Conservation kit

  • Portable unit (motor and suction)
  • 3 in 1 syringe
  • Handpieces and burs
  • Light source
  • Syringes, needles, needle guards
  • Mirrors
  • Conservation instruments and tray

Materials

  • Temporary dressing materials
  • Restorative materials
  • Matrix bands
  • Gauze
  • Suture materials haemostatic agents
  • Bite packs
  • Dry socket medicament eg Alvogyl
  • Local anaesthetic cartridges
  • Topical anaesthetic cream/spray
  • Oraquix local anaesthetic plus applicator
  • Cotton wool rolls and pellets
  • Vaseline

Periodontal Kit

  • Hand scalers
  • Portable ultrasonic scaler
  • Toothbrushes, toothpastes and therapeutic agents, eg Corsodyl, Tooth Mousse

Surgical Kit

  • Syringes, needles, needle guards
  • Mirror
  • Forceps
  • Elevators
  • MOS instruments including instrument for suturing

Transporting Contaminated Instruments

If instruments are transported off the premises on a public highway, those who are responsible for the transportation should follow the requirements of the Carriage of Dangerous Good and Use in Transportable Pressure Equipment Regulations 2007 and the Health and Safety at Work Act 1974.

Instruments being transported must be part of a consignment note, and records should be kept of:

  • What items are being transported (for example dental instruments)
  • Time of dispatch
  • Intended recipient

The consignment note should be placed visibly within the vehicle the instruments are being transported in, and a contact telephone number should be available.

This is to provide evidence and an audit trail for record keeping purposes.

For dental practices in Scotland, Health Protection Scotland states that appropriate labelling should be in place when transporting through public access areas, but it does not stipulate the requirement of a consignment note . The labelling should indicate:

  • The sender
  • The intended recipient
  • That the contents may be contaminated

All dental practices must have a policy and protocol on the transportation of instruments, detailing segregation of contaminated and clean instruments, staff must be aware of this documentation.

Due to carrying contaminated instruments the dental care professional must ensure their indemnity insurance covers this activity.

Transportation Boxes

Guidance documents request that dedicated transport boxes are used which are:

  • Rigid
  • Robust
  • Easy to clean
  • Capable of being closed securely
  • Leak proof

Transportation boxes should be clearly marked to identify the contents, either contaminated or clean instruments. A colour coding scheme is often preferred to distinguish between contaminated and clean instruments transportation, however it is still advisable that they are clearly labelled.

Transportation boxes are not interchangeable. This mean that’s a box designated to carry contaminated instruments cannot then become the transport box for clean instruments, and vice versa.

Transport boxes are required to be kept visibly clean, this can be achieved through a single disinfectant wipe or washing the boxes with detergent and leaving to dry. Transport boxes should be cleaned between each use or when visibly dirty.

Comments

very good content

As part of the NHS Dental Department this seems to be the way our clinic is going. We are reverting back to being a Community based clinic.

Very informative..Easy to understand and covers all aspects of dental treatment that can be acheived in a non clinical enviroment

Couple of other points/questions. We no longer provide domi' treatment due to all the 'red tape'
Do you have to notify the CQC, so that domicilary visits are part of your regulated activity? Are there any insurance issues with carrying oxygen in your car? I once heard you should display a sticker on the outside of the car advising people you are carrying 02, is this true? Thanks

Thank you for the above enquiry. Should a practice start providing domiciliary care and terminate this service then they need to notify the CQC through updating the statement of purpose. You will need to consult with you indemnifiers in regards to carrying oxygen in a vehicle. The signs on the vehicle may depend based on the amount of oxygen being transported. If you are carrying a small amount of medical oxygen it may not be required to display hazard warning signs on the vehicle. Speak with the oxygen supplier company in regards to the signage to be displayed on the vehicle, they may also be able to provide guidance on how to correctly store the cylinder during transportation to limit fire risk.

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