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Preadmission / Screening for Adults. August 3, 2009 CDS 824- Dr. Theiss Team Leaders- Drs. Nihill, Harrison, Carroll, McConnell, Ray Videos courtesy of Drs. Falace, Lindroth and Herren. Preadmission. Determines if patient eligible for student clinic Reviews clinical policy

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preadmission screening for adults

Preadmission / Screeningfor Adults

August 3, 2009

CDS 824- Dr. Theiss

Team Leaders-

Drs. Nihill, Harrison, Carroll, McConnell, Ray

Videos courtesy of Drs. Falace, Lindroth and Herren

preadmission
Preadmission
  • Determines if patient eligible for student clinic
  • Reviews clinical policy
  • Establishes the patient’s needs and desires
  • Review health and dental histories
  • Cursory exams
    • Head and Neck Screening
    • Missing teeth, periodontal risk, Caries risk and oral cancer risk
  • Informs patient of “generalized” estimate of treatment needs
  • Provide “rough” estimate of costs and options
screening appointments
Screening appointments
  • Patients call 859-323-6525
    • They will reach Donna Mason or Phyllis Dean
  • They also tell patients that this first appt is screening only to determine if their needs fit the needs of the dental students.
  • This screening is for
    • Comprehensive Care NOT Urgent Care…
      • Urgent Care- different process
  • They will also inform patient that
    • “we are NOT a free clinic”, but student fees are generally
    • one-half to one-third of private practice fees.
screening appointments donna and phyllis also tell patients
Screening appointments: Donna and Phyllis also tell patients
  • This appointment will take 2-3 hours
  • You should bring any existing “x-rays”
  • You should bring a list of or a bag with your medicines
  • The fee will be $40, that must be paid that day and will not be covered by insurance
transitions
Transitions
  • Paper to Electronic
  • Review of all forms
  • Formal review of procedures this fall for
    • Screening
    • Oral Diagnosis
    • Treatment Planning
    • Will use Toyota “Lean” assessment and action tools.
    • Multiple faculty, staff and students will be involved
  • STAY TUNED
screening appointments donna and phyllis also tell patients1
Screening appointments: Donna and Phyllis also tell patients
  • You will likely have a panoramic “x-ray” taken
  • You will be seen both by faculty and by students during screening
  • At the end of the appointment will know if eligible for comprehensive care at UK COD
  • If accepted into program, treatment is by students who are supervised by faculty and residents
slide7
Appointments made in AxiUMElectronic Patient RecordNew to COD- get T-number until show up then get a regular number assigned
screening patients are appointed
Screening patients are appointed
  • AM- scheduled at 8 and 8:30
  • PM- scheduled at 1 and 1:30

Purposely staggered to help with long lines and urgent care patients who often arrive at 7:30

  • Students scheduled at 9:00 and 2:00
registration forms
Registration Forms

1A- form general demographic information used by registration staff to enter into AxiUm electronic Patient Record.

The patient is then assigned a regular AxiUmpatient number.

1C- Preadmission summary form student record general findings, missing teeth, periodontal probing> 5mm, carious lesions

Team Leaders or OD faculty review findings and help determine fee estimates

at radiology reception area patients review complete additional forms
At Radiology reception area- patients review & complete additional forms
  • 3A- Medical History- Front and Back
    • and signed by patient
  • HIPPA- Notice of Privacy Practices
  • Receipt of HIPPA form must be signed
  • Clinical Research Contact Form-
    • can consent to be contacted by Clinical Research Center for one year from signature
other informed consent
Other informed consent
  • As we speak the UKDCB- University of Kentucky Dental Care Board is reviewing multiple consent forms to use for our patients.
  • These may be available by the time you start seeing your own patients
patients rights and responsibilities
Patients Rights and Responsibilities

You have the right to:

  • Considerate, respectful and confidential treatment:
  • Continuity and completion of treatment;
  • Access to complete and accurate information about your condition;
  • Advance knowledge of the cost of treatment, explanation of your treatment fees and informed consent to treatment;
patients rights and responsibilities1
Patients Rights and Responsibilities

You have the right to:

  • Explanation of recommended treatment, treatment alternatives, the option to refuse treatment, the risk of no treatment and expected outcomes of treatment;
  • Emergency, incremental and total patient care;
  • Treatment that meets the standards of care in the profession;
  • Access to a patient advocate;
patients rights and responsibilities2
Patients Rights and Responsibilities

Your responsibilities include:

  • Providing accurate and complete information about your medical history;
  • Questioning treatment or instructions you do not understand;
  • Keeping scheduled appointments and providing at least 48 hours notice if you need to cancel an appointment;
  • Providing information about payment for services and working with the college of dentistry to ensure that financial obligations are met.
team leader in radiology
Team Leader in Radiology
  • Meets patients
  • Inquires Needs and Desires
  • Quick review of Medical History
  • Quick review of Clinic policy
  • Intraoral Screening
  • Prescribes Screening radiographs
radiographs then taken or reviewed if bring x rays with them
Radiographs then taken or reviewed if bring x-rays with them
  • Typically most patients will get a Panoramic film and if teeth 2-4 Bitewing radiographs
  • On occasion if one tooth in pain may get periapical radiographs
  • We don’t do full mouth radiographic series during preadmissions generally
clinic policy
Clinic Policy
  • Patients must be available for ½ day session every other week

AM session: 9-12 PM PM session: 2-5PM

  • Patients must be on time,
    • Patients who are regularly late, cancel frequently or no show

will likely be dismissed from Comprehensive Care program

  • Patients for Comprehensive Care must agree to Phase I treatment- Control of Dental Disease
  • If Patient dictates… I only want this… then they are not Comprehensive Care patients, they are either urgent care or on occasion – Endodontics only or Ortho only patients and will be referred accordingly.
clinic policy payments
Clinic Policy- Payments
  • Patients must either pay at time of treatment or arrange a payment plan
  • Payment plans are arranged with
  • Jordan Kirby- financial counselor – 2nd floor
  • Payment Plans- 10% down, remaining balance paid in monthly increments for 1 year- can be divided – Phase 1 only or

both Phase 1 & Phase 2

radiology technicians jeanine lisa and melody
Radiology Technicians- Jeanine, Lisa and Melody
  • Radiographs will then be taken by Radiology Technicians
  • Patients will wait until developed (until we have digital available) and cleared
  • Patients will then report to either the 3rd floor clinic or the 2nd floor clinic. (wherever screening is scheduled that day)
patient arrives to 2 nd 3 rd floor
Patient arrives to 2nd/3rd floor
  • Depending on time (before 9 am or after)
  • The patient paper chart and radiographs will arrive with faculty or Angie Baxley, RDH for you to preview
  • After 9 am, the patient may bring the chart up with them and give it to Phyllis Dean on the third floor
in the meantime you arrive after class
In the meantime….. you arrive after class
  • You will have been assigned a cubicle and patient (look in Axium for where and who)
  • You should check out red, blue pencil and blood pressure cuff and sphygmomanometer
  • You should sign up ahead of time

for a diagnostic exam cassette

Note: different then last year when DAU set out cassettes… since 3 went missing, you now have to sign out in your own name.

your cubicle will be disinfected and ready for you thank you dau
Your cubicle will be disinfected and ready for you Thank you DAU
  • Get Personal Protective Equipment
    • Gown from back of clinic
    • Gloves
    • Bring Eye protection, magnification if desired
  • Get Safety glasses for patient
  • Place saliva ejector suction tip in holder on ‘assistant side’
  • Verify unit functions: Light, water, suction
continued operatory patient set up
Continued operatory/ patient set up
  • Purge water lines- 3 minutes in air water syringe. Not necessary for handpiece hoses during screening since not using handpieces.
  • Get ONE packet of gauze
  • after seating the patient, obtain an Oral Diagnosis Guide form (1D) from the forms file at the rear of the clinic floor and follow the instructions
  • Verify have patient signature pad attached to your monitor… will need for electronic signatures
axium view if patient checked in
AxiUm- view if patient checked in
  • Log in-
  • Click on Scheduler
  • Look at your schedule- IF patient checked in, patient name will be in RED
  • Select patient by right clicking on appointment in scheduler

New this year: staff (Donna and Phyllis) will be calling and confirming screening appointments in addition to automatic reminders.

when paged or chart delivered
When paged or chart delivered
  • Review radiographs in general, some patients have been previous patients and may have other films to review.
  • If return patient -check chart entries (may have been in urgent care or oral surgery recently and now wants comprehensive care
  • Verify x-rays belong to your patient
  • Review medical history for “red flags”

(remember patient is waiting so seat them

OK to review with the patient in the chair)

review panoramic and other films can mark missing teeth in axium her and or 1 c preadmissions form
Review Panoramic and other films- can mark missing teeth in Axium HER and/ or1 C Preadmissions form
find and bring patient to operatory
Find and bring patient to Operatory
  • Go to waiting room,
  • Call out patient name and introduce yourself
  • Escort patient back to your cubicle
  • Patient may have spouse or companion
  • OK to bring 1 person back not family of 5
  • Seat patient, give eyewear protection
if patient checked in but no chart
IF patient checked in but no chart
  • See Team Leader or Angie Baxley to inquire
  • Sometimes patients check in but we dismiss them in radiology for a variety of reasons.
  • You will likely be assigned to assist another student or work in another discipline (urgent care or oral surgery
seat patient and view axium
Seat patient and view Axium
  • Try to position yourself you are able to enter findings in Axium at the same time you can make eye contact with patient
  • Open patients Chart in Axium select Electronic Health Record Icon
  • Select Forms Tab
initiating data collection in forms tab add a new form
Initiating Data Collection: In Forms tab…. Add a new form
  • Chief Complaint form
    • Fill out chief complaint form as interview patient
  • Medical History form
    • Will then need to ADD A NEW FORM to add Medical History (unless already completed previously in Axium) then will only update
    • Use paper 3A and review as enter into Axium
    • Every positive response requires a “dialogue box” explanation
  • Dental History form
slide43
Note medical alerts
  • Bottom in RED
  • Top under alerts
  • COMMENTS ADDED HERE
medical history resources micromedex for drugs
Medical History Resources- Micromedex for drugs
  • IN AxiUm are links for pharmacological references that you can look up medications
  • In Urgent Care office have additional reference texts to use for Medical History
  • DO NOT REMOVE from office without permission.
take blood pressure reading
Take Blood pressure reading
  • Record in Axium
  • Take pulse- record in Axium
  • Bottom of Medical Hx
perform oral cancer screening
Perform Oral Cancer Screening
  • Oral and paraoral soft tissue examination
  • Record findings unusual findings in top of 1D form
  • Answer questions:
    • Is patient in Pain, etc.
    • Do they need immediate or preliminary care prior to comprehensive care?
    • Is there a medical concern that needs to be addressed?
    • Etc.
stop call faculty to review before proceeding
STOP- Call faculty to review before proceeding
  • Do not proceed until faculty have reviewed chief complaint, medical history and your initial findings.
  • After discussing with faculty
  • HAVE THEM SWIPE approval
    • Chief Complaint Form in Axium
    • Medical History Form in Axium
    • Dental History Form in Axium
once approved can proceed with hard tissue examination
Once approved can proceed with hard tissue examination
  • With radiographs on viewbox
  • Review hard tissue clinical findings tooth by tooth to determine clinical needs: caries, broken teeth, defective restorations

Use 1C preadmission form to document

(later will enter in Axium and will be able to differentiate radiographic vs. clinical findings)

hard tissue examination caries defective restoration broken missing teeth etc under findings
Hard tissue examination caries, defective restoration,broken, missing teeth etc under FINDINGS
once review hard tissue can proceed to soft tissue periodontal exam and occlusion
Once review hard tissue can proceed to soft tissue Periodontal exam and Occlusion
  • Will “spot” probe and mark and probing depths > than
  • 5 mm on

1C preadmission form.

ANGIE BAXLEY, RDH can assist you in perio and other charting

  • Review OCCLUSION
previser risk assessment tool
Previser- Risk assessment tool
  • Evidence Based tool
  • For assessing risks:
    • Oral Cancer
    • Dental Caries and Tooth Fracture
    • Periodontal Disease

http://www.previser.com/

discuss findings with team leader or od faculty member
Discuss findings with Team Leader or OD faculty member
  • If time permits will obtain preliminary consultations NOT definitive since do not yet have diagnostic casts, additional radiographs etc.
  • Endodontics Oral Surgery
  • Periodontics Oral Pathology
  • Prosthodontics
consult findings
Consult findings
  • Open Axium forms tab
  • ADD Consult Form 5A for faculty or residents to fill out.
  • They can do it at another operatory as long as they have the patient axium number and name.
estimates
Estimates
  • After consults with specialty faculty or residents
  • Review findings with Team Leader or OD faculty.
  • Discuss general treatment options
  • Determine if patient eligible for Student clinic
  • If not, refer to graduate clinics or faculty practice
  • If so, determine treatment and fee estimate. If possible estimate # appointments
fees are available in axium links
Fees are available in Axium links
  • Team Leaders and OD faculty will assist you in looking up fees online
  • Remind patients this is an ESTIMATE only
  • Review findings with patient
  • Have patient sign bottom of 1 C form that they understand is an estimate only
verify
Verify
  • Patient has signed 1 C form (estimate only) Give them second copy keep original
  • Patient has signed online forms with signature pad
    • Medical History
    • Dental History
  • You will also sign and
  • Faculty will sign or swipe
after reviewing findings
After reviewing findings
  • Ask patient what they think about what you discussed
  • Ask if they have any questions
  • (may need to bring team leader back to discuss)
  • Determine if interested in returning for Comprehensive Care as regular patient
  • Review again Clinical policy on availability and cancellations etc.
complete 1 d form oral diagnosis guide form
Complete 1 D form = Oral Diagnosis Guide Form
  • Will determine which additional radiographs needed
  • Need for Diagnostic Casts
  • Need for additional consults
  • Etc.
patient eligible and interested
Patient eligible and interested
  • Determine if needs additional radiographs- if so have faculty sign for or swipe
  • Discuss with Team Leader if best assigned to you or another member of your team
  • Assignments based on student experience and patient needs
  • Take patient to Team Coordinator
  • They will schedule Radiology/ OD appointment

Note: when multiple appts in one session must be made by Team Coordinator

simple patients
Simple patients
  • If screening patient has minimal disease
  • May be able to screen quickly and proceed immediately to Comprehensive Data collection (all hard and soft tissue charting)
  • Won’t need more than panoramic or BW’s
  • Can treatment plan same session
all patients
All patients
  • Go to Axium Treatment history and
    • ATTACH Progress Note to Screening procedure in Axium
  • SHAPED format
    • S= Section and faculty (ie. Screening/Dr. Ray)
    • H= Health status
    • A= Assessment or Diagnosis- include patient chief complaint here and general description of findings, what tx options discussed
    • P/E= Screening and consults
    • D= Disposition or what planned next (ie x-ray and OD)
      • If not eligible- why
      • If no longer interested-why