Four keys to success in the ‘new normal’ – transitioning back from a UDC to community care

Dentist working at a UDCFoundation dentists Aliya Remtulla, Kelly King and Mahad Farrukh discuss their transition from a UDC to community care following lockdown.

COVID-19 has forced many dental practices into an unprecedented introspection as to how they should function safely during a novel pandemic. Recent data from the Office for National Statistics reveals out of the 10 healthcare occupations having the greatest risk of exposure to COVID-19, dental nursing ranks right on top. Dental practitioners and technicians are also sixth and eighth on the list respectively. It has resulted in the need for robust measures to be devised and implemented in order to optimally protect patients and employees.

Back in March, the chief dental officer for England duly announced an immediate halt on routine dental care. In light of this, the UK formed urgent dental care centres (UDC). These centres have the necessary facilities to provide emergency dental care at a regional level. In line with national standard operating procedures (SOPs), UDCs have adopted radical changes with uncompromising infection control measures at the forefront.They became examples for how dentistry can resume safely.

As all dental practices begin to make tentative steps towards returning to routine service, we can now take numerous lessons from how UDCs have successfully provided face-to-face treatment over the past few months.

Community Dental Services Bedfordshire (CDS-CIC) has been running a UDC to serve the region of Beds, Herts and Bucks. As foundation dentists working for this service, we are in the fortunate position of witnessing how our practice has applied particular methods. We would like to discuss four key elements that GDPs can implement moving forward.

1. Flexible team roles and adapting processes

As we have seen, the gold standard cross infection control methods have undergone numerous adaptations over the last few months. These constantly evolving changes have, at times, felt overwhelming to keep on top of.

In order to provide some clarity and structure, our organisation tailored the national SOP for local use. We ensured all colleagues had access to this.

We hold regular meetings to keep everyone informed of major changes. This has been of great benefit. It enables all colleagues to have an opportunity to partake in reflection of these guidelines with a voice to provide any feedback.

We expect that in the initial days of starting treatment, certain processes and procedures will be slower than before. Therefore, it is crucial to meticulously prepare, prior to undertaking treatment.

Morning huddles

Team briefs at the start of each day are absolutely essential, so that every member is clear about the roles they need to partake in, as well as knowing what patients are coming in.

The use of pre-made packs or creating lists, detailing all of the necessary equipment, has been beneficial in reducing errors and improving efficiency.

Utilising other team members is often essential to escort patients in and out of the surgery. And also to access any additional equipment where necessary during treatment. This ultimately ensures the reduction of unnecessary patient contact where possible.

We operate utilising two surgeries for treatment. One surgery as an entrance and waiting room, and separate surgeries for donning and doffing PPE.

As a large practice, we have the ability to utilise our space to the maximum and ensure that we can follow the national SOP. For smaller practices this isn’t possible. Therefore, more innovative methods may need consideration.

Contacting local UDCs can help dental practices to discuss solutions and overcome challenges when implementing changes in smaller spaces.

2. Diligent social distancing measures

One of the biggest challenges dental practices face is maintaining social distancing within the premises. Whilst also still having a sufficient workforce present each day.

Our UDC is fortunate to have the capacity to enable a group of up to 15 employees to attend work each day. However, we still observe certain measures to allow social distancing amongst colleagues.

For tighter corridors, we have allocated certain surgeries as ‘ducking rooms’. Employees can briefly ‘duck’ into one of these rooms to allow members to safely walk through a corridor, whilst maintaining social distancing.

Where possible, we have introduced one-way circuits to reduce the likelihood of colleagues walking towards each other.

Waiting rooms are not in use for patients but we can still utilise these as makeshift common rooms for everyone to sit together and have lunch. Such areas provide more space to allow seating two metres apart.

It is important to be able to switch off and de-stress; social distancing shouldn’t restrict the valuable opportunity to get together and reflect after a chaotic morning.

3. Utilisation of new techniques and reviving older methodologies

Very early on, our UDC adopted alternative technologies to overcome limitations with telephone consultations.

We were given access to an iPad, which hosts the Accurx system. This NHS-approved, encrypted platform enables video consultations to any patient who has access to a smartphone. This has proved to be valuable in confirming the presence of swellings, assess the severity of lesions, and make a more informed decision as to whether the patient requires a face-to-face appointment.

The promise it shows begs the question as to whether this could be the new norm of assessing and screening patients. In reality, this could enable a more thorough history taking, whilst reducing face-to-face assessment time. Therefore minimising the risks of spreading infection.

As our understanding of what constitutes an aerosol generating procedure (AGP) develops, we can utilise this to determine which treatments are possible without the need for AGPs.

New non-AGP alternatives may come to the forefront. Whilst some older methods such as hand excavation and scaling may play bigger roles than previously envisaged.

A recent webinar highlighted new methods of reducing AGPs. Some of the examples discussed were the role of silver diamine fluoride as a more potent preventative agent. And the use of self-etching adhesives when bonding with composite.

Furthermore, the use of separate air and water systems were discussed, in place of the traditional three-in-one. When the three-in-one is used in conjunction, it poses the risk of generating aerosols.

As clinicians, we will think outside the box and utilise new methods.

4. Transitioning to the ‘new normal’

As CDS Bedfordshire gradually begins to resume routine dentistry, we have had to devise ways to organise our remobilisation.

Deciding which patients to prioritise is difficult. But allocating an RAG rating (red, amber and green) is a great way to aid this process. We base the rating on previous pain histories, relevant medical history, caries risk assessment and proposed treatment. This helps determine the urgency with which they need seeing.

It creates a systematic approach to re-booking patients in for treatment. Having a spreadsheet or document with a clear identification of non-AGP and AGP patients is particularly helpful.

Prior to attending, it is also essential that we inform patients about what to expect from the appointment. This can assist in creating a positive experience, which is especially important for paediatric and anxious patients.

Providing information through emails and videos helps alleviate any fears a patient may have about coming to the practice. Additionally, the patient is more aware of the protocols.

Working from home

Given that not all team members are in the practice at all times, it is a great time to utilise the capabilities of staff working at home.

This can be through creating social media marketing strategies or even improving patient relationships through wellbeing checks over the phone. It’s good to remember this is the perfect opportunity to improve our patient contact.

Similarly, it is important that we also help and support our peers in any way we can. Strengthen support networks between neighbouring practices, and share ideas on how to run safely and smoothly.

The need for emotional support is well documented throughout this global health crisis. This also extends to our colleagues and peers across the wider profession.

We should strive to be approachable and open to directing our team members to places they can get help should they need it. This is the time now, more than ever, to reach out and connect with other members in our local and national communities.

Conclusion

The future of dentistry still remains unclear. But what is certain is that we can learn from the experiences of the UDCs that have been operating throughout the pandemic.

Each practice and service will face its own unique problems, but these can be partially overcome through the four points discussed above.

As we return to offering routine dental care, the knowledge provided by national guidance and UDC successes can give a great insight into how we can get back on our feet as a profession.

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