Responsible to: Dental Nurse Manager
Location: RNI Community Hospital, Inverness
Department: Dental Services
Operating Division: South East Highland Community Health Partnership (Hosted Service)
Job Reference: SEHIGHCOMMDENT08
No of Job Holders: 5
Last Update: 01 March 2006
2. JOB PURPOSE
To carry out Dental Nursing and administrative duties in support of Dental Services delivered by dentists and hygienists of the NHS Highland Health Board. This post has specific duties and responsibilities related to the care and treatment of vulnerable adults and children.
Provision of routine and emergency dental care to a range of adults and children who experience either one or more of the following barriers to care: learning difficulties, complex medical needs, dental anxiety, behavioural difficulties and social exclusion. The planning and provision of dental care must be carried out within the context of each individuals barriers. These conditions range from mild to severe and include high risk mental health patients. The environment is generally unpredictable and situations require to be carefully managed to ensure safe working at all times.
Based across 2 different sites, the RNI Community Hospital and New Craigs Hospital, work is in a variety of settings on a peripatetic basis, including single and multiple surgery dental clinics, hospital dental clinics, dental mobile units and domicillary visits to patients homes, nursing homes and hospital wards. The post holder will be required to work flexibly across a variety of services including; Salaried, Community, General Anaesthetics, Relative Analgesia and IV Sedation. Although based predominantly within the Vulnerable Patients team the post holder may be required to work elsewhere where necessary to cover staff absence.
4. ORGANISATIONAL POSITION
See attached organisational chart.
5. ROLE OF DEPARTMENT
The Dental Department assists NHS Highland in the maintenance and improvement of the oral health of local communities within the area through:
the delivery of routine and emergency dental services to local communities
the delivery of the epidemiological function through the National Dental Inspection Programme
the delivery of the national toothbrushing programme to all nurseries and designated primary schools
the delivery of specialist services (eg general anaesthetics & sedation)
the delivery of care in a variety of settings (eg domicillary care & care from mobile surgeries)
participation in community wide oral health initiatives
6. KEY RESULT AREAS
Chairside assistance during all procedures, providing support to the dentist and dental hygienist. Assist the dentist during minor oral surgical procedures.
Assist in the supervision of the compromised patient requiring special care dentistry.
Monitor the patient during recovery to check that measurements return to normal. Ensure post-operative instructions have been given, and that once discharged the patient is escorted safely from the premises.
From dentists instruction advise patients on details of treatment and aftercare within level of knowledge. Ensure that the patient and carer have a clear understanding of the proposed treatment. Send written information and follow this up to check understanding and ensure pre-treatment instructions are carried out.
Chart the patient’s oral health status from the dentist’s / dental hygienist’s instructions.
Safe disposal of hazardous and clinical waste in appropriate container. Includes soft waste contaminated with body fluids (e.g. paper towels, swabs), sharps, waste amalgam, and x-ray developing fluid / fixative.
Process and mount x-ray films where required, assisting the Dentist during the taking of x-ray films.
Completion of standard operating procedures in accordance with the NHS Highland X-ray Quality Assurance programme.
Clean and sterilise instruments and maintain clinical environment, adhering to Departmental and NHS Highland protocols and procedures. Ensure that prescribed standards of decontamination are met and all documentation completed.
Follow all protocols in relation to the central sterilisation of instruments at Raigmore Hospital. Responsible for checking that the correct instruments are on the tray prior to treatment, and for signing the tray off prior to returning it for sterilisation.
Maintenance and inspection of surgery equipment and instruments in line with standard operating procedures.
Organise domicillary visits if the patient cannot travel to the clinic. Liase with community nursing staff / carers and prepare equipment and materials in advance. Provide support to the dentist during the visit.
Assist patients with mobility difficulties during procedures, adhering to NHS Highland Moving and Handling protocols in order to minimise the risk to staff and the patient. This may include the use of a hoist and other moving and handling equipment.
Promotion of good dental health during the patient’s visit, providing oral health advice to patients, carers, staff and parents / guardians.
Participate in the development of protocols for specialist dental services where required.
Deal with patient telephone enquiries and liase with parents, carers, schools and special needs centres to arrange and issue appointments, maintaining confidentiality at all times.
Preparation of letters and instructions for specialist services.
Liase with other health care departments (e.g. Anaesthetics, Hospital Ward Staff, Hospital Clinicians) in order to co-ordinate dental treatment and ensure that the appropriate tests are carried out before and during treatment.
Liase with anaesthetics secretary, ward and waiting list staff to arrange for medically compromised patients to be admitted as an inpatient to hospital for theatre.
Ensure patients with dental emergencies receive appropriate prioritisation, as per the NHS Highland Dental Services emergency protocol.
Organise paper, electronic records and filing associated with the delivery of Community Dental Services, General Dental Services, the National Dental Inspection Programme and Specialist Services.
Ensure safe storage of dental and hospital medical records, liasing with reception and medical records staff. Transport patient records between clinics and for domicillary visits.
Check that consent has been given and the relevant documentation has been completed prior to treatment.
Record daily treatment and complete day book/sheets and attendance forms.
Record, calculate and handle patient fees, receiving payment and banking where required. Where necessary complete paper work for referral of patient accounts to the Finance Debtors Department.
Deal with the paperwork associated with dental laboratory work and orders.
Deal with other general paperwork relating to the Salaried and Community Dental Service.
Day to day ordering and stock control of all dental materials. Carry out stock audits where required.
Ensure that all dental equipment is maintained regularly, notifying the correct NHS department promptly with regard to faults or problems
Work placement support and guidance to Trainee Dental Nurses working in the clinic. Provision of observational feedback to the Trainee’s SVQ Assessor as requested. Work placement support for Qualified Dental Nurses studying for the Special Care Dental Nursing examination.
Participate in on-call rota for Out of Hours during weekends.
Provide cover for staff absences (planned and unplanned) in clinics within daily travelling distance of base. Flexible working practices are required as some requests can be at short notice.
Work in mobile dental units; set up water, electrical and drainage connections and dispose of clinical waste from holding tanks.
7a. EQUIPMENT AND MACHINERY
Dental Equipment and instruments; autoclave, ultrasonic, washer/disinfector, dental cart, aspirator, LA syringes/cartridges, oxygen cylinders, velopex, amalgamators, x-ray machine, light curing lamp, sharps and emergency equipment / drugs
Working knowledge of the electronic Practice Management System for Primary Care Dental Services.
Working knowledge of Microsoft Office systems (e.g. Word, Outlook) where appropriate
Working knowledge of the administration systems associated with the delivery of Community Dental Services and General Dental Services.
8. ASSIGNMENT AND REVIEW OF WORK
Post holder has freedom to carry out routine tasks. The Dentist / Hygienist reviews standards and performance on a day to day basis.
The Senior Dental Nurse reviews, at least monthly, over all standards and performance against the agreed protocols.
The post holder will review their development needs annually with the Senior Dental Nurse, as part of the NHS Highland Personal Development Planning and Review policy.
9. DECISIONS AND JUDGEMENTS
In conjunction with the senior dentist, triage referrals directing them to the most appropriate clinic (e.g. medically compromised, phobic patients). Make a judgement on the appropriateness of referrals; referring to the senior dentist when a referral is thought not to be appropriate.
Allocate appointment times, including the prioritisation of emergencies. This is often under significant pressure from patients who may be in pain and/or have been waiting a considerable length of time. Highlight patients who may require to be fast tracked through the system.
Stock ordering and control; ensuring that adequate levels of stock are maintained at all times bearing in mind available storage space.
10. MOST CHALLENGING/DIFFICULT PARTS OF THE JOB
Maintaining a positive mental attitude while working with a demanding patient group. Managing these patients when they are anxious or in pain and may in some instances be aggressive or confused.
Moving and handling of patients who are in pain and have complex medical problems (e.g. MS, MND, CP) so that treatment can be carried out effectively and comfortably for all involved.
Making quick and effective decisions with regard to the management of the patient, in often stressful and demanding circumstances.
Prioritisation of patients in a very busy service where the expectations of the public are high.
Patients, relatives, carers, social work, mental health services, GPs and ambulance service to organise and advise on dental care.
Hospital services to organise specialist care; Anaesthetics, Oral Surgery, Hospital In-Patient Services, Patient Transport Service
The dentist / dental hygienist in order to provide chairside assistance and organise dental care for patients.
Senior Dental Nurse, Clinic Head Nurse, other support staff within own dental clinic
On a weekly / monthly basis, as required :
Other departments within NHS Highland; Dental Helpline, Dental HQ, other dental clinics, other hospital services and nursing staff
Support departments e.g. Estates, Finance, Stores
External agencies e.g. Dental Directory, nursing homes, schools, school nurses
The post holder maintains regular contact between the patient, carer and all agencies involved in the care of that patient where relevant to their dental management. This involves multidisciplinary working, with relevant information being shared with the multidisciplinary team when necessary.
The post holder provides and receives complex and/or sensitive information to patients and carers. The majority of these patients do not readily understand or accept instructions, e.g. medically compromised patients, adults with learning difficulties or behavioural problems. The post holder must overcome this and develop a good relationship with patients and their carers in order to reassure them about their dental treatment.
The post holder must work well as part of a team of dental support staff. There is a close working relationship between the dental nurse and the dentist / dental hygienist in particular, working as a pair during all consultations and procedures. This necessitates excellent communication skills.
12. PHYSICAL, MENTAL, EMOTIONAL AND ENVIRONMENTAL DEMANDS OF THE JOB
Assisting the dentist to manage and reassure vulnerable and demanding patients whom are often anxious, in pain and confused. Patients can be very ill, and some are terminally ill. Maintaining a positive mental attitude can be difficult and is very emotionally demanding.
The post holder works with patients who have very limited mobility, are in pain and/or are medically compromised. This can be very physically demanding and the post holder may be required to stand in awkward positions for a period of time. They will require to use moving and handling aids and techniques in order to treat these patients effectively and comfortably.
Regular dentist-led IV sedation sessions, and Anaesthetist-led General Anaesthetic and IV sedation sessions are both physically and mentally demanding.
Providing chairside support during routine clinical procedures including endodontics, surgical extractions and complex restorative procedures. Anticipating what the dentist requires during the procedure and being actively involved (i.e. 4-handed dentistry). Significant concentration is required.
Carrying out exposure prone procedures, minimising the level of exposure by using appropriate protective equipment. This includes sharps, bodily fluids, bacterial loaded aerosol (caused by invasive work), radiation and toxic chemicals.
Setting up and working in a dental mobile in all types of weather including cold and difficult conditions. Connections for mobile units are not always easily accessible. Working within the confined space of a dental mobile is often demanding.
The moving and handling of stock items can be physically demanding e.g. packs of sterile water.
Travelling to other clinics to cover staff absences at short notice requires flexibility and can be emotionally demanding.
Required to assist the dentist in managing a medical emergency, which may on occasions involve resuscitation of a patient. This is a rare event.
13. KNOWLEDGE, TRAINING AND EXPERIENCE REQUIRED TO DO THE JOB
National Examination for Dental Nurses/Modern Apprenticeship Dental Nursing Level 3
National Examination for Special Care Dental Nursing qualification essential. Post holder must commit to achieving this within 2 years of taking up post.
Qualification in Inhalations Sedation desirable. Essential if monitoring patients during the IV sedation clinic.
Good understanding of the services and departments within the acute care setting, how they function and interact (e.g. Sterile Services, Anaesthetics, Outpatients, Oral Surgery).
Knowledge and understanding of how to deal with patients who have specific medical conditions. Patients are often ASA category 3 or 4.
Knowledge and understanding of the complications that may arise following ENT, Oral Surgery and Oncology treatments.
Significant post qualification experience within the dental surgery in a variety of settings, including experience in working with vulnerable patients
Experience of administration associated with primary care dental services.
Up to date in respect of NHS Highland mandatory training relevant to the post; Resuscitation, Moving and Handling, Violence and Aggression, Fire Safety.
Current knowledge of Dental Cross Infection Control and up to date training in the use of autoclaves.
Experience of multidisciplinary team working
Experience of caring for others, particularly those with mobility difficulties, learning difficulties and behavioural problems
Able to communicate effectively with a wide range of individuals, including those who present barriers to communication