Last summer, a Dentists’ Provident member in her 30s suffered an unexpected stroke while at work. She was signed off work for just a month, and received over £2,000 from Dentists’ Provident, while she underwent a number of tests and consultations. By putting in place suitable protection, she was able to focus on her recovery and treatment, mitigating the impact of the financial consequences of unexpected ill health.
While every dental practice has a duty of care to ensure patients are in
a safe environment when undergoing dental treatment, this case highlights the need to look after your own health and income too. The care of patients
is the very foundation of good practice and is regulated by both the General
Dental Council (GDC) and the Care Quality Commission (CQC). These bodies’ written regulations set out their expectations regarding equipment, resuscitation training, clinical governance, risk management and the regularity of clinical audits, as well as the aforementioned standards of care.
The GDC’s Scope of Practice 2013 reminds us that: “A patient could collapse on any premises at any time, whether they have received treatment or not. It is therefore essential that all registrants are trained in dealing with medical emergencies, including resuscitation, and possess up-to-date evidence of capability.”
Essentially, it is important to be prepared for anyone – be it a patient, a member of staff or, indeed, yourself – to be the victim of a medical emergency, with the latter two potentially having a major impact on the smooth running of your practice.
If the medical emergency leads to a longer term sickness absence, this can
have a marked impact on the team, whether you are a practice principal or an employer in a hospital. According to the Resuscitation Council, dental teams should be well versed in the emergency procedures; and health and safety training should be updated regularly. Resuscitation equipment should be audited every week, at least, and other health and safety concerns,
such as handling of equipment, should be audited at regular intervals.
We all hope we never have to face an emergency, but a survey of dentists in England published in the British Dental Journal in 2012 demonstrated that medical emergencies do happen more often than you may think. It showed that some 300 respondents said they had encountered the following, over a 12-month period:
? Vasovagal syncope (63 per cent) – 596 patients affected
? Angina (12 per cent) – 53 patients affected
? Hypoglycaemia (10 per cent) – 54 patients affected
? Epileptic fit (10 per cent) – 42 patients affected
? Choking (five per cent) – 27 patients affected
? Asthma (five per cent) – 20 patients affected
These are obviously also conditions that can affect a dentist as well, and this can have an impact on their ability to work, Dentists’ Provident’s 2013 claims statistics include migraines with claims paid of over £20k, vertigo and balance problems over £2,000, epilepsy of nearly £5,000 and asthma over £2,000.
More than half of all employees have either been made redundant or suffered long term illness during their working life, highlighting the value of protecting their income, research by MetLife Employee Benefits suggests. The nationwide study showed that 23 per cent of employees questioned had been off work for periods longer than four weeks.
Increased financial pressures on workers and the risk of long term ill health during a working life is an issue that employees and employers need to be aware of, and to guard against where possible, particularly as the research shows that 41 per cent of workers admit they could not afford to live on statutory sick pay. In April, the weekly rate of statutory sick pay increased to only £87.55 and, at the same time, the Government abolished the statutory sick pay percentage threshold scheme, which allowed employers to recover amounts of statutory sick pay.
Dentists’ Provident’s claims statistics also demonstrate that conditions that dentists have experienced could potentially cause long term sickness absence. In 2013 Dentists’ Provident paid claims for conditions such as myocardial infarction for over £20k; strokes for over £40k; over £145k for fractures, over £55k for Parkinson’s disease and over £85k for road traffic accidents.
The raft of standards that came in with the introduction of CQC practice inspections added another layer of expectations regarding health and safety measures, in relation to the preparation – and equipment – for medical emergencies. This guidance states that it is a practitioner’s responsibility to ensure that medicines required for resuscitation or medical emergencies are easily accessible in tamper-evident packaging. The CQC also addresses
training, outlining that “all staff involved in using the equipment must have the competency and skills needed and have appropriate training”.
Former dental nurse Wendy Berridge is now a CPR, first aid, medical emergencies and defib trainer at Berridge Medical Training based in Yorkshire. She is passionate about the necessity for the whole dental team to have the knowledge – and confidence – to cope in a medical emergency.
She explains: “I cannot stress enough how important it is for every member of the dental team to receive the relevant training, in order for all staff to work together should a medical emergency happen at work.
The training will ensure that everyone has the confidence and capability to quickly and efficiently deal with the situation, and to administer the correct first aid to the casualty. Medical emergency training should be undertaken on a yearly basis as recommended by the Resuscitation Council (UK).”
And although, for example, cardiorespiratory arrest is rare in primary dental practice, there is, as the Resuscitation Council outlines, an expectation that dental teams should be competent in treating cardiorespiratory arrest.
It states: “All primary care dental facilities should have a process for medical risk-assessment of their patients and specific resuscitation equipment should be available immediately in all primary care dental premises. This equipment list should be standardised throughout the UK.”
The old adage of ‘practice makes perfect’ is key here and, according to the Resuscitation Council, dental staff’s knowledge and skills in resuscitation should be updated at least annually.
Dental Protection Limited, as a professional indemnity provider, provides outlines to practice teams on the expectations for dealing with medical emergencies. It maintains that: “The records of all staff training sessions must be available to the CQC. Practices are advised to hold training sessions and simulation exercises at least quarterly. There must be written practice protocols for dealing with collapsed patients, with which all staff should be
familiar. European Resuscitation Council guidelines should be printed off, laminated, and kept with the emergency drug kit. Signs and directions should be displayed in the practice to show where the emergency drug kit is kept. This must not be kept locked, or in a locked cupboard or room whilst the premises are occupied. If the practice has an automatic external defibrillator (AED) staff should be trained in its use and a record kept. Internal signage should be used to indicate the whereabouts of this machine. It is also desirable to have a sign outside the building to indicate that an AED is kept inside.”
So, when putting all of these systems and plans in place for dealing with patient medical emergencies, make sure you protect your own health and income too, so that a medical emergency does not have a detrimental impact on your health or finances.
Bryan Gross, head of claims and underwriting at Dentists’ Provident, summarised by saying: “It is important for dentists to make sure they are
protected. Medical emergencies can affect you as well as your patients and, although it is important to ensure systems are in place to protect your patients, it is also essential to consider your own financial and personal health protection and prevention, should sickness or injury affect you.”
References available on request.