Community dentistry plays a crucial role in providing oral care to patients with complex needs or medical vulnerabilities. However, this specialised field also poses unique challenges for dentists, and if not managed properly, it can lead to legal implications.
The Importance of Community Dentistry
In the United Kingdom, there are over a million people with complex needs, including severe learning disabilities, who struggle to access dental care. Additionally, approximately 140,000 individuals are bedbound, making it impossible for them to visit a traditional dental clinic. Consequently, treating vulnerable patients in the community has become increasingly common but remains challenging.
Challenges and Legal Issues
Patients with complex needs may present communication difficulties, struggle to follow instructions, or require dental treatment outside of a clinical setting, such as in their own homes. These unique challenges make the administration of oral care more complex and increase the likelihood of legal issues arising if situations are mismanaged.
Tip #1: Always Obtain Informed Consent
Obtaining informed consent is an essential part of the clinician’s duty of care, particularly when dealing with patients who have limited decision-making capabilities or difficulty understanding complex information. Written consent is highly recommended in these cases to ensure patients or their guardians fully understand the proposed treatment plan, including its risks and benefits. Failure to obtain informed consent can be considered negligent. For vulnerable adults unable to make welfare decisions, it is crucial to obtain signed consent voluntarily from a dedicated guardian.
Tip #2: Ensuring Patient Safety
Patient safety is well-established in a controlled clinical environment. However, when treating patients with complex needs or providing home visits, maintaining safety becomes more challenging. Lawsuits related to safety malpractices are unfortunately common in these situations. To mitigate risks, dental practitioners should have protocols in place to manage worst-case scenarios, such as situations where a patient becomes agitated or uncooperative. Maintaining a calm demeanour, speaking softly, reassuring the patient, and treating them with respect can help diffuse difficult situations while minimising harm to the patient and the dental team. Alternatively, when a patient needs to be treated in their own residence, ensure safety protocols are in place like:
- Initiating pre-arrival instructions – Prior to a visit, confirm patients do not smoke before arrival, pets are kept separate, and patients are correctly positioned to receive dental treatment.
- Zoning for infection control – Even in a small space such as a bedroom, it is imperative to designate a work area for infection control and to maintain cleanliness at all times. A pre-visit inspection is helpful to be able to plan zones and declutter.
- Carrying the correct kit – Emergency drug kits, defibrillators, clinical waste and sharps boxes, and dirty instrument boxes are all essential to manage patient safety. A kit checklist is helpful when doing domestic visits and helps ensure no equipment or instruments are left behind.
Tip #3: Understanding Legal Requirements
Dental practitioners in community dentistry must be aware of legal requirements and regulations related to accommodating patients with complex needs, mobility issues, or challenging behaviours. In the UK, if you fail to make your practice accessible for those who are less mobile or have complex needs, you are likely to be in breach of Principle 1 of the Standards For The Dental Team and Regulation 9 of the Quality Care Commission’s Health and Social Care Act 2008. Understanding these legal principles enables practitioners to assess their practice’s needs, make necessary adjustments, and comply with the law.
To avoid potential legal implications in community dentistry, it is essential to establish clear procedures and policies for treating patients with complex needs, mobility issues, and challenging behaviours. Retraining staff, implementing systems for informed consent, and understanding the legal requirements for treating vulnerable patients are critical steps in minimising the risk of legal action.
Feel free to contact us at Dental Defence Society for comprehensive support and legal advice and to gain peace of mind and ensure compliance with legal considerations in community dentistry.