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A few months ago, I was temping at a dental office. I was there on a long term fill in for maternity leave coverage and felt comfortable with their flow. One day I heard the other hygienist say, “Tina I need you to get the doctor for me ASAP”. She said it in a clear and calm voice. In a manner in which I understood she needed help. As I got up and walked past her room, I saw her quickly laying the patient back and using reassuring words as the chair went down.
She had just given an injection and the patient had a syncope event. As I went to alert the doctor, I realized I didn’t know what their emergency protocols were. Even though I was “just temping” I should have known this and where the equipment was. Thankfully, it was a minor event and was easily handled. However, I am embarrassed to say that I never even asked about their emergency protocols. After the event I spoke with the doctor and the rest of the clinical staff about this situation. What was uncovered from that conversation is, they hadn’t reviewed their own protocols in a while and were even a little unsure of what their process was as well.
Thankfully, it was a simple enough situation which was easily handled. But more importantly it served as reminder for everyone to pause and look at what the office process is.
If your state is like Oregon, we are required to have a medical emergency course for each license renewal period. So, we sit in class, nodding our heads as we have heard the same information over and over, get our continuing education certificate, and leave. But what about after the class? Does that knowledge just stay in the lecture hall? Do you sit down and discuss the protocols for your office? If your office doesn’t already have a protocol regarding an emergency situation now is the time to get one in writing and practice it.
When creating your game plan, you should think about these questions. What is the alert system in the office? What tasks need to be handled in an emergency? Does everyone know his or her role? Who calls 911? Who grabs the medical emergency kit? Who’s in charge of documenting the event and recording the patient’s vital signs? If someone is out of the office for the day, who will take over his or her duties?
Understanding the answers to these questions helps you and your office have a clear and defined system in place when the emergency happens.
So how can you reinforce a smooth flow of a sticky situation?
PRACTICE...
Practicing how to handle different emergencies and different roles will make everyone’s experience of the emergency much smoother. Some experts suggest reviewing medical emergency situations every 6 months. Acting out the situation from beginning to end sets you up for success. I suggest taking turns being a patient and acting out symptoms of the common emergencies. Yes, I know that can be silly. Think of it as team bonding, but it will reinforce what you need to look for in an emergency and how to handle it. Don’t forget the most common emergency to happen in an office is syncope, but practicing other emergencies like seizure, hypoglycemia and cardiac events is just as important.
Along with practicing how to handle different situations as a team, you should review the roles of each person. Ideally each staff member has a specific role and tasks during an emergency. A lot of this depends on the size of the dental practice, but ideally there are at least three people involved in a flow of emergency care. Here is an example of the three roles.
Lead Person:
The lead person is handling the emergency and the patient. He or she is actively caring for the individual provided the necessary aid. This person also directs others into action.
Secondary Person:
The secondary person should bring the medical emergency kit and begin the process of taking vitals. It is important to record and report vitals, medications and actions taken as needed. Not only is this information important for the patient’s chart, but should EMS arrive they will need this background information as well. The other task for the secondary person is to provide relief for the lead should he or she need it.
Additional Support Person:
The third person (perhaps more) are additional support people. Their task is to oversee the office flow should outside help from the Emergency Medical System be needed. They provide details over the phone to 911 and guide EMS to the scene. This person would also attend to any immediate office management issues which could occur due to the emergency. Such as rescheduling patient appointments.
Finally, make sure this information is in an easy to read and grab manual. Listing out the step by step process and incorporate recommended medications for each emergency. Also, include the different roles and the tasks for each team member. Documenting the office team members who have practiced the different roles could be helpful for your general practice management strategies.
Having a manual that is easily accessible can be a great resource in the event of an emergency. Especially if there is a fill-in clinician or new employee. Even better, if there is ten or fifteen minutes of downtime any staff member can do a quick review of this notebook. By the way, this manual is the perfect spot to keep records of weekly medical emergency kit checks, the eye wash station review log and other office safety information.
At a minimum everyone in the office should review these protocols and physically practice managing them twice a year. Practice them throughout the office including the operatory and reception area. Don’t forget about the bathroom or the staff area. Remember, it’s not just the patient who could experience an emergency. It could be a member of the office. In fact, one of my dental hygiene friends had to perform CPR on the doctor in the reception area! Talk about a shocking moment.
Remember most emergencies happen right after giving an injection. Don’t get caught off guard when it happens. Following these three simple strategies of practicing protocols twice per year, reviewing the roles of each person, and keeping an easy to read manual on hand will help you and your office mates stay cool, calm, and collected. While we never want an emergency to be a routine experience, we do want to experience it as if it were routine.
Feeling prepared for what can happen after an injection will help you give YOUR BEST SHOT.
Cheers,
Tina
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