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A retrospective service evaluation of safeguarding activity in a dental
general anaesthesia service.
Elizabeth O’SullivanJulie Kelly
City Health Care Partnership Hull
BackgroundDental General Anaesthetics (DGA) were moved into
hospitals only in 2001Prior to this 15% of all UK DGA’s were carried out in
Hull in General Dental PracticeGuidelines for the management of children referred for
DGA published in 2011Recommended that assessments and treatment planning
was carried out by a specialist in Paediatric DentistryCHCP Hull took over this service as a specialist led
service in 2012DGA carried out in hospital by same provider as
previously
Population StatisticsHull 2011 Census East Riding 2011
CensusPopulation 256,500Children (0-16) 62,00024% of populationEthnic Minority 12.4%Childhood Poverty 32.9%
Population 334,000Children (0-16) 72,00021% of populationEthnic Minority 4.9%Childhood Poverty 13%
Multi-Disciplinary teamReferring Dentist – GDP,
SDS - proformaSpecialist Led Assessment
Service – working in a community setting with close links to Health Visiting, School Nurses and Safeguarding practitioners
General Practitioner Led GA Extraction List in Acute Hospital on Saturday am
ObjectivesTo evaluate the
safeguarding activity in a new Dental General Anaesthetic Referral Service
To use a multi-disciplinary team approach to address issues for those families who fail to engage with dental services.
Vulnerable PatientsChildren with high decay
experience, from socially disadvantaged families represent a high need group.These children are more likely to have safeguarding issues or come from minority groups requiring an interpreter for appointments.
Service evaluationContinuous service evaluation carried out as
know vulnerable group of patients:
Failure to attend appointmentsIssues with consentInterpreting Services
Safeguarding referrals
First AppointmentInstructions regarding venue and time of
appointmentWhat they need to bring with themWho needs to attendPaperwork around consentEvaluation of interpreting needs
Failure to attend AppointmentsFailure to attend 1st assessment appointment:2012 – 21%2013 - 17%2014 – 17%Carers get a telephoned appointment
together with written/posted instructionsText or telephone confirmation of
appointment the day before
Failure to attend appointmentsIf failed appointment: letter sent advising of failed
appointment, asking them to phone in to make another and information regarding sharing information with GP, health visitor, school nurse, safeguarding
Posters in waiting area alerting carers to fact information shared
Introduction of policy to share information with other healthcare workers/social care
Immediate information sharing with our service if fail GA appointment
ATTENTION PARENTS /CARERS.
In the interest of service improvement and the benefit of safeguarding children,
information may be shared with other Health care professionals, such as GP, Health Visitor or School Nurse.
Information SharingAssessment sheet collects not only Dental
and Medical InformationAlso
School/Nursery child attendsHealth VisitorGPSocial Care involvement
Failure to attend appointmentsAbove policies have lead to 74% of patients
that initially fail to attend being seen at a second appointment.
Patients failing to attend 2nd or 3rd appointment are followed up and are likely to get a social care referral.
ConsentIssues with consent: adults without PR
attending assessment appointments, carers not understanding who can consent
Wasted appointments/ Repeat appointments
Education of referring GDP’sTelephone information to carers when first
appointment madeSame person signing consent attending both
assessment and GA appointment
Interpreting servicesGrowing part of serviceIn 2012 only a handful of patients needed an
interpreter.Now 18%
Different health beliefs around GA, extracting decayed teeth
Use of interpreters when safeguarding issues arise
ConclusionsChildren in certain parts of the country have
no access to specialist led services for dental treatment under general anaesthesia. This often leads to poor treatment planning, repeat GA’s and failure to assess safeguarding issues adequately.
By highlighting best practice and the very real safeguarding issues associated with this group of children we can help other services in the commissioning process of specialist services