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Clinic Policy Manual

Medical Emergencies

Subject:   Medical Emergencies
Effective Date: January 1994
Revision Dates: January 2002, September 2015, January 2016

Purpose

To provide procedures for the prevention and management of medical emergency situations in the clinics of the School of Dentistry.

General Policy

Accepted patient assessment techniques shall be utilized to identify and properly manage patients who present as a high medical risk.  In the event of a serious medical emergency the approved protocol for managing the emergency shall be followed.

Minor medical emergencies such as cuts, burns, and chemical exposures which require first aid shall be managed in accordance with the safety policies of the University of Washington.

Documentation of medical emergencies shall be done in accordance with the School’s Safety and Quality Improvement Program and when appropriate, State law.

All providers should acquaint themselves with the location and contents of, the first aid kits and the emergency equipment available in the clinics.

Implementation

I. Major Medical Emergencies

A. Prevention Strategy

Patient assessment techniques which meet the standard of care shall be used to determine the appropriate management of a patient during dental visits.  Patient assessment and management shall include, but will not be limited to, the following:

  1. All patients of the School shall have an adequate medical history with appropriate medical alerts and an assessment of vital signs once every year including pulse rate, blood pressure, and respiratory rate which are recorded in the patient record.
  1. Coordination of dental care with the patient’s physician when indicated by the patient’s medical history. Always take not of any medical history alerts in the patient record and take precautions consistent with alert.
  1. Referral of patients with significant medical complications to clinical facilities (e.g., AGD clinic) which have the appropriate equipment and expertise to safely manage the patient.
  1. Selection of local anesthetics which are compatible with the patient’s medical condition.
  1. Prescription of appropriate premedication regimens, post-operative medications, and instructions related to the dental procedure (e.g., diet, rest, etc.).
  1. Appointment of patients at times and for durations to be consistent with the medical condition and treatment of the patient.
  1. Avoid use of any medication, product, or device to which a patient has an allergy.

B. Preparation

 In all clinical sites within the School, the following emergency equipment shall be readily available and appropriately maintained:

  1. Portable oxygen supply with regulator
  2.  Disposable oxygen mask and tubing
  3. Bag-valve-mask combination (or Pocket MaskÒ) and oral airways
  4. Oro-pharyngeal suction
  5. AED are available in the locations below:
    • Faculty Practice
    • Advanced General Dentistry
    • DECOD
    • Dental Urgent Care/ Oral Medicine
    • Endodontics
    • Graduate Pros
    • Orthodontics
    • Oral Surgery
    • Pre-doc clinic on D2 and D3
    • D1 Simulation Clinic and Labs (D165)
  1. Standard emergency drug kit consisting of:
    •  Albuterol Inhaler
    • Baby Aspirin 81 mg tablet
    • Benadryl (Diphenhydramine) 25 mg tablet
    • Nitroglycerin 0.4 mg sublingual tablet #100
    • Epi-Pen 0.3 mg syringe
    • Instaglucose
    • Ammonia Inhalants

For sites where parenteral or multi-agent conscious sedation is administered, additional equipment and emergency drugs for ACLS are required (i.e. OMFS, Perio, AGD Clinic, & Dental Fears).

Similarly, sites in which deep sedation or general anesthesia are administered are required to have extensive additional equipment as required by the Disciplinary Board (WAC 246-817-760, which can be accessed at the following link: http://search.leg.wa.gov). Basic drug kits are provided by OCS.  Additional drugs required by Level I clinics are maintained by the department.

C. Medical Emergency Procedures (potentially life threatening)

In any situation in which a loss of consciousness or other potential medical emergency is suspected, the following procedures are to be instituted in sequence.  The protocol is posted in each clinic cubicle and updated annually (Appendix A).

  1. Patient placed in a supine position, except in cases of congestive heart failure (CHF)
  1. Airway opened, and oxygen administered
  1. Vital signs taken, pulse, respiratory rate, and blood pressure
  1. Call for appropriate medical assistance*
  1. Provide symptomatic treatment
  1. Patient transported only when stable or by EMS personnel

*In cases of cardiac arrest or other life-threatening emergency, activate the EMS system by calling Medic I at 911. State the nature of the problem, therapy instituted (e.g., CPR).  When possible, call from a School land line, then the call will go directly to UW Police. If necessary to use a cell phone, make sure to state that you are calling from the University of Washington Health Sciences Building. The School’s street address is 1959 Pacific Ave. Make sure to provide your wing, room number and, identify the meeting place at the loading dock between the D- and B-Wings.  State that a person will meet the aid car there and escort them to the site of the emergency.  Stay on the line to allow the dispatcher to ask questions; let the dispatcher hang up first.

D. Medical Emergency Procedures (non-life threatening, non-body fluid exposure)

 Use First Aid kit, if necessary.  Contact personal health care provider or Hall Health Primary Care Center (685-1011) OR in other serious, but not immediately life threatening, situations requiring follow-up medical care the Emergency Department at UWMC can be contacted by calling 8-4000.  Ask to speak to the attending physician or resident and state the nature of the problem and therapy provided.  The patient may be billed for treatment if it is unrelated to dental care.  If indicated, the patient can be transported to the Emergency Department, located on the second floor of the east wing of the UWMC.  Wheelchairs are available in Oral Medicine, DECOD, Oral Surgery, and on D3.  Note:  Campus Health Services at UWMC is for body fluid exposures ONLY for staff, faculty, and students.

E. Aftercare Procedure

  1. In all cases of medical emergencies, patients should receive an appropriate level of follow-up care, including return evaluation in the School of Dentistry, or care by the patient’s physician.
  2. The Director of Patient Relations and the student/provider shall contact the patient and/or the patient’s family when appropriate following the medical emergency to coordinate the resolution of medical bills related to the emergency and to express concern for the patient and/or family.

II. Minor Medical Emergencies

A. Minor Injuries during Patient Care

Faculty, students, and staff who receive puncture wounds, lacerations with   instruments or devices contaminated in the patient care process, or experience splatter in the eyes with body fluids from a patient shall receive appropriate first aid on site and contact the UWMC Employee Health Nurse (Campus Health Services, Room NE210 in the main hospital) at 598-4848.

Body Fluid Exposure Procedure for Dental Students, Staff, and Faculty

  1. Immediately remove soiled clothing and wash exposed area with soap and water. (Use eyewash station or saline rinse in case of eye exposure.)
  2. Notify supervising faculty.
  3. Note the severity and type of exposure and assess likelihood that patient is at risk for HIV.
  4. If a SOD workforce member receives a bill from the UWMC, it should be delivered to the Director of Patient Relations within 30 days or you will be responsible for payment. Delivery may be made in person to the Patient Services Office in Health Sciences room B-452B or mailed to the Office of Patient Services, Attn: Manager of Patient Relations, Box 357131, Seattle, WA 98195-7131.

B. Minor Injuries Unrelated to Patient Care

  1. Minor injuries in the workplace which are not related to patient care shall be treated by trained personnel using First Aid kits provided by the University.  Persons specifically trained in First Aid shall be identified in both the B- and D-wings to provide appropriate First Aid. A Patient Event Report must be completed for all incidents and emergencies using the online form. (Appendix B).

C. Maintenance of First Aid System

A designee in each clinic shall appointed and will be responsible for the maintenance of First Aid Kits in their clinic. The Director of Safety is responsible for arranging ongoing trainings school wide.

III.  Event Reporting

A. Event Reports

In accordance with the School’s safety program, all patient injuries and medical emergencies shall be reported to the OCS within five working days of the incident.  Use the Event Report form in Appendix B for such reports. The OARS reporting system should be used of student and employee accidents and medical emergencies.

B. Dental Disciplinary Board Reports

Any injury related to a dental procedure which results in the hospitalization, or death of a patient must be reported to the Dental Quality Assurance Commission (DQAC) Disciplinary Board of the State of Washington within 30 days of the incident (WAC 246-817-780 accessed at the following link: http://search.leg.wa.gov ).  Principal parties are to report such events to the OCS using the confidential event reporting system stated above.  The provider involved in the event must report to the DQAC, and in student cases, the Associate Dean of Clinic Affairs or delegate will submit the report.

IV. Basic Life Support (Health Care Provider Level “C”)

A. Clinic Personnel

All students, faculty, and staff who engage in direct patient care must be certified in “Basic Life Support” at least every two years.

B. Non-clinic Personnel

All employees are encouraged to receive training in “Basic Life Support” even if they are not involved in patient care.  Such training may be useful in providing emergency assistance to co-workers, visitors to the School, and family members.

Appendices:         

Appendix A, Medical Emergency Procedures

Appendix B, Patient Event Report

Dean of UW SOD:

Joel Berg, Dean of the UW School of Dentistry

February 2, 2016

Appendix B

Patient Event Form