Swallowing of Foreign Objects

Subject: Swallowing of Foreign Objects
Effective Date: December 8, 2008
Revision Dates: February 2011, September 2016

Purpose

To establish a fast track for patients who swallowed an object to radiology, by-passing a possible long waiting time and charges in the Emergency Department.

General Policy

Swallowed objects may represent a significant health hazard as well as a malpractice risk. Timely treatment can prevent serious complications.

Implementation

If a patient under your care swallowed an object (castings, implant components, orthodontic band, etc.) during your treatment, it is judicious to assume it has been aspirated, even if the patient exhibits no symptoms of airway obstruction. Aspirated objects pose an immediate hazard to the patient’s life. Swallowed objects may also pose a serious health risk.

1. Check to confirm that your patient has a patent airway. If the patient has trouble breathing, lips turning blue or skin turning a dusky color, not able to speak or shows any signs of distressed breathing, call 911 immediately or send someone to call 911 for help (see Appendix A, Medical Emergency Protocol and Appendix B, Emergency Quick Reference Lanyard Card.)
2. Reassure the patient chairside.
3. Inform your supervising faculty and the Clinic supervisor.
4. Inform the patient of the need for a chest x-ray to determine the location of the object.
5. Obtain a prescription order form to UWMC radiology services (See Appendix C, RRR Clinical Research Requisition Order Form U2535 & Instructions) from the dispensary and have the supervising faculty sign it, authorizing the imaging order.
6. You or a staff member should transport the patient in a wheel chair to the UWMC Radiology/Imaging Services located on the second floor in the SS wing, room SS-202A for appropriate radiographs. (Note: The patient will be registered into the UWMC system at the radiology service if they are not a current patient of the center.)
7. If the patient is absolutely certain he/she ingested the object rather than aspirated it, it is still optimal to refer for medical evaluation and follow-up imaging. In every instance, referral to a physician is the most prudent course of action, as it demonstrates that you are acting in the patient’s best interest. Explain to the patient that there can be instances of aspiration without symptoms.
8. Document the event in the patient’s EHR, your actions following the event, and the patient’s decision about follow up. This should include your recommendation of a medical evaluation, including imaging, how the patient was transported for medical evaluation and by whom, and any telephone discussions with the medical facility and treating physician. A copy of the treating physician’s report should be added to the patient’s record.
9. Document all preventive measures (rubber dam, pharyngeal drape, etc.) that had been taken to prevent the swallowing or aspiration of the object and any pre-treatment referrals or discussions about referrals.
10. Complete an online event report using the Patient Event Form see Appendix D, Patient Event Form.*
    *Choose Patient Event Form from RequestManager

Appendices:

Appendix A, Medical Emergency Protocol
Appendix B, Quick Reference Emergency Card
Appendix C, RRR Clinical Research Requisition Order Form &
Instructions
Appendix D, Patient Event Form

Dean of UW SOD:

Joel Berg, Dean of the UW School of Dentistry

APPENDIX A: Medical Emergency Protocol (PDF)

APPENDIX B: Emergency Quick Reference Lanyard Card

APPENDIX C:
RRR Clinical Research Requisition Order Form U2535 & Instructions (PDF)

INSTRUCTIONS to complete the UWMC Radiology RRR Clinical Research Form for SOD workforce members is below.
1. TODAY’S DATE:
2. ORDERING MD/PRACTITIONER: Print the complete the name of the SOD attending faculty – both first and last name are required. (Leave the MED STAFF ID# blank.)
3. MD/PRACTIONER SIGNATURE: Attending SOD faculty should sign on line
4. BEEPER NUMBER: Enter the phone number for the D2/D3 Clinic Manager – 221-3038 or Other__________________
5. PRECAUTIONS: Check boxes or fill in any information which may apply pertaining to pregnancy, allergies and medical conditions listed.
In the box in the lower right corner list:
6. PATIENT NUMBER (Pt. No.): list the UWMC Patient number, NOT the SOD patient number.
7. PATIENT NAME: Complete full name
8. DOB: Month, date and year

Location of UWMC Radiology/Imaging Services:

APPENDIX D: Patient Event Form*.
*Choose Patient Event Form from RequestManager