11 January 2011

Q. Our practice recently held a CPR/medical emergencies update session. It covered the administration of first line drugs ie. oxygen, adrenaline, glucose, glucagon, midazolam, GTN, aspirin and salbutamol.

As a registered dental hygienist, I wanted confirmation that I am allowed to administer these drugs in an emergency. Is this also the case for the registered dental nurses at this practice?

Because a medical emergency can occur at any time either prior, during or subsequent to treating a patient, every member of staff, not just the registered team members, has a role to play if a patient collapses or if there is any other kind of medical emergency. The GDC advises in its Guidance that all members of staff who might be involved in dealing with a medical emergency should be trained and prepared to deal with such an emergency at any time and practise together regularly in a simulated emergency so they know exactly what to do. There should always be arrangements for at least two people available in the practice to deal with a medical emergency when treatment is planned to take place.

Quite rightly your practice has arranged for the dental team to undergo training in dealing with a medical emergency, and should such an emergency occur when a dentist is present in the practice then the dentist would normally be responsible for managing the emergency. The response might include making an emergency call to the paramedics as well as implementing life support, which may or may not include the administration of drugs. Any DCP involved in the management of a patient in an emergency should provide support to the patient working under the direction of the dentist.

It is possible that a situation arises where a dental hygienist is working in the practice without a dentist being present. However, it would be expected that in such circumstances the dental hygienist would be accompanied by another member of staff who should be competent in assisting in the event of a medical emergency. In these circumstances the dental hygienist would need to make a clinical decision based on their own knowledge and competence on how to deal with the emergency. A hygienist would be expected to be competent in maintaining a patient’s airway and administering oxygen and to give directions if necessary to the nurse or receptionist to make a call to the paramedics. Whether or not a hygienist administers any form of drug therapy such as adrenaline, glucose etc will depend on whether they are in a position to make a diagnosis and have the competence and experience in administering these drugs.

Although most hygienists would not be expected to administer drug therapy, there are a number of hygienists who have had the necessary training to be able to make a diagnosis and make a decision in the patient’s best interests about administering these drugs before the paramedics arrived. Every clinical decision has to be made after considering a number of factors which might include the cause for the patient’s collapse and the proximity of the local hospital.

In an emergency you would have to decide if it would be in the patient’s best interests to administer one or more of these drugs in the absence of a dentist before the paramedics arrive. Indeed it is desirable that any dental hygienist or therapist working in a practice without a dentist should be in a position to deal with any patient who develops an adverse reaction to any treatment which has been administered.

Normally a dental nurse will have had sufficient training to be able to assist a dentist or dental hygienist in the event of an emergency and it is obviously incumbent on the practice owner to ensure that all members of staff have regular training in CPR. However, if the dental nurse has had previous training and experience in CPR and was the only person available to deal with a medical emergency, then as long as the nurse is working within their area of competence and expertise it would be difficult to criticise that nurse if they were genuinely acting in the patient’s best interests when no-one else was available.

Dental Protection Limited is registered in England (No. 2374160) and is a wholly owned subsidiary of The Medical Protection Society Limited (MPS) which is registered in England (No.36142). Both companies use Dental Protection as a trading name and have their registered office at 33 Cavendish Square, London W1G 0PS.

Dental Protection Limited serves and supports the dental members of MPS with access to the full range of benefits of membership, which are all discretionary, and set out in MPS’s Memorandum and Articles of Association. MPS is not an insurance company. Dental Protection® is a registered trademark of MPS.

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