Lisa Pilkington asks if you know what to do.
While the protocols for safeguarding vulnerable patients are of course essential in any healthcare setting, it remains a difficult area to address. While professionals receive a significant amount of training when studying at university, many will have little experience of such a situation in practise and so may be unsure about exactly what is expected of them.
The safeguarding regulations set out by the CQC (outcome 7) are quite generic, but they bring professionals’ responsibility to safeguard patients to the forefront. It is important that all members of the team understand what is required of them.
The pathways that should be followed in the event that a professional suspects a child or vulnerable adult may be experiencing abuse or neglect are as standard across the country. The line-manager or safeguarding lead within the practice should be notified, and if further information is needed or a referral is necessary, then the local safeguarding authority should be contacted. It is important for professionals to share their concerns with someone else, and confidential information sharing protocols should be in place and followed in such situations.
As a sensitive area of any healthcare provider’s responsibilities, there are barriers that dental professionals need to overcome in order to act appropriately when protecting vulnerable patients.
Professionals can often be afraid to report suspected neglect for fear for getting into trouble. Whether that’s with regards to sharing information or approaching the subject with the patient themselves, it is crucial that they have the confidence to deal with the circumstances effectively. Abuse or neglect is not always obvious and can be difficult to recognise, as well of course as being slightly subjective. For example, if there is a child patient who has 10 caries and who shows few signs of any improvement in their oral health, is that a form of neglect on behalf of the parents? If clinicians are concerned then simply speaking to another professional about it can help clarify their suspicions and help them follow protocol.
There are also further ways of making the protocols clearer for both professionals and their patients. Increasing patient awareness of a professionals’ duty to safeguard vulnerable people can help build practitioners’ confidence in the matter. Whether that involves placing posters or leaflets in the waiting area, or breeching the subject during patients’ initial enrolment with the practice, this can be hugely beneficial.
For the latter, it is important to softly explain that dental professionals have a responsibility to protect their patients, and that they are simply doing their jobs should the topic ever be brought up. The more information practices can gain the better, so it may also be good to include a few questions in the registration forms such as ‘Does your child have a social worker?’ If the answer is yes, then a private and gentle conversation would be advisable – for some it may simply be to help with a disability, while the practice will know to be particularly vigilant for those who have been identified as a potential protection risk in the past.
When approaching the subject with regards to adults, questions such as ‘Do you have a carer?’ or ‘Who is your next of kin?’ are important. It may also be worth asking ‘Should you at any point not have the capacity to provide consent for yourself, who would you like us to ask?’ Also known as an ‘express wish’ or ‘desire’, adding these questions to the standard enrolment papers can limit the potential embarrassment caused by asking such things at a later date.
Care plans should also be taken into consideration when treating patients from residential or care homes, and follow ups are particularly important to ensure that the proposed treatment plan is being adhered to correctly.
Patient consent is of course a difficult area with regards to vulnerable patients, and steps can and should be taken to ensure the highest possible quality of consent is acquired every time.
Non-compliance with CQC regulations with regards to either safeguarding or patient consent can of course have serious consequences for healthcare providers. It is therefore crucial that practices have a framework in place to show how staff should approach situations and to demonstrate that these have been adhered to. I often recommend tools such as SafeSeen Touch to help practices evidence their compliance.
It is paramount that you know and understand the safeguarding protocols in order to help protect your more vulnerable patients. Whether you have a flowchart available in reception, an accessible hardcopy document or an electronic pathway set out, make sure you have the confidence to act appropriately if the time comes.