21 December 2010
Q. I employ an associate who regularly leaves his patient in the surgery with the dental nurse whilst goes outside to get fresh air or to get something to eat. The nurses are unhappy about him doing this particularly after giving an injection. Is this professional behaviour?
It is not uncommon for some dentists to administer local anaesthetic to a patient and then send them into the waiting room (where they may not be supervised or observed) whilst waiting for the local anaesthetic to take effect. Similarly some dentists work between two surgeries and may leave the patient in the chair either alone or with a dental nurse.
There are a couple of potential problems which could arise as a result of this type of practice.
From a clinical point of view any patient may have an immediate or delayed reaction to the local anaesthetic and it is obviously important that the dentist is alerted and that if the patient is accompanied by a dental nurse, the nurse is able to at least start to deal with an adverse clinical scenario. The other issue at stake is whether the dental nurse’s position could possibly be compromised because there was not a third party to act as a chaperone.
The GDC’s guidance advises dentists that a third party should normally be present when carrying out treatment and this could be interpreted to encompass the supervision of a patient after the administration of local anaesthetic.
The main concern here is why this dentist appears to be acting in this way on a reasonably regular basis. From a practice management point of view you may wish to set protocols within your practice to ensure patients are provided with a high standard of service and care and you therefore may wish to advise your associate that you would wish him to sit with the patient unless there were other acceptable reasons for leaving the surgery. You may need to take further advice if he fails to comply with your wishes.
At the end of the day the treating dentist will be responsible for the care of their patient and should the patient develop an adverse reaction while the dentist was not present then that dentist would have to provide a cogent reason why he believed it was in the patient’s best interests to leave them with the dental nurse. The training and experience of the dental nurse will also have a bearing on any decision made by the dentist. If a dental nurse feels that the patient could be at risk because of their own particular level of experience, then it is very responsible act to have brought this to your attention.