DENTAL PRACTICE ARTICLES
Take Charge of Your Emergency Response and Practice Recovery Plan
The forced closure of your dental office has, in many ways, pressed the reset button on your daily operations.Now is the time to restart your practice and take proactive steps to prepare for a full and robust recovery post COVID.
The intent of this article is to provide you with practical recommendations to help you and your teams adjust to the “new normal” and prepare for future growth. This is a dynamic, fast moving situation of which you have no control. You can prepare an effective response to the crisis and use what we have all learned from this to prepare for the future.
Your team needs to feel that it is safe to return to work and know what procedures to follow, as some of their job duties may have changed. Your patients also need a compelling reason to return to your practice feeling confident that all reasonable steps have been taken to keep them safe. Optics will play a major role in your patients’ perception, so if they see the receptionist wearing a mask sitting behind a Plexiglas shield, it will be part of the new normal for the next few month.
As with any recovery process, it will be incremental and your practice will not be running at full speed immediately and possibly for some time to come. There are steps that you can implement now as part of your Emergency Response Plan that will help enhance the recovery process and prepare your practice for a possible second wave. Although we hope that does not come to pass, being prepared is always a good recommendation.
Implement a Team Communications Plan
It is important to prepare your staff for possible changes in their hours and duties when they return to work. Most dental offices will have employment agreements in place that should provide enough flexibility to make necessary changes without violating the rights and protections provided to employees under the Employment Standards Act. If you do not have employment agreements in place, it would be a good idea to consult with an employment lawyer to see what your options are when recalling staff. Your staff will be anxious to return to work, however, it is necessary to follow the guidelines providedby the regulatory bodies and a full return to work for all of your team members will take some time and will likely occur in phases.
Now is a good time to hold a staff meeting through Zoom or Go to Meeting to discuss the changes and start preparing for opening. Holdinga virtual staff meeting will help them to feel connected and engaged in the process. Involve your Health and Safety Representative and/or your Joint Health and Safety Committee. Discuss details of the Emergency Response Plan. Some topics that you may wish to discuss may be:
• Prescreening procedures for staff and patients. What will that look like and who will be doing the prescreening and how will it be done?
• How to maintain physical distancing when checking in patients. How many patients will be in the reception area at the same time?
• How to disinfect the reception area and how often?
• Will you be installing Plexiglas guards at the front desk?
• How patients should be confirmed and prescreened?
• What the schedule should look like moving forward including how much time should be booked for hygiene appointments?
• How should patients be prioritized?
• Post visual alerts (e.g., signs, posters) at the entrance and in strategic places to provide instructions about
hand hygiene and respiratory hygiene and cough etiquette.
Ensure that your infection prevention and control (IPAC) processes are up to date as well as your Occupational Health and Safety program. These are dynamic processes that require continuous updates, review and adaptations to current events. As employers, you are responsible for safe delivery of your services as well as the protection of your staff during these challenging times. Now, more than ever, it is critically important to be compliant with the most current infection prevention and control procedures.
Preparing the Patients – Communications Plan
The flow of good reliable information is more important than ever. Staying in touch with your patients now will help your practice to recover more effectively. This is the time to reach out to your existing patients to let them know how much you care about them and you are committed to their safety and wellbeing. Many patients don’t know what a “true” dental emergency is so this is an opportunity to inform your patients about the difference between a dental urgency and a true emergency. You can also let your patients know how to reach you directly. It would also be helpful to post information on your website and all social media channels.
Provide your patients with information about the steps that you are taking to keep them as safe as possible when they return to your office. Also, inform them about what to expect when they return such as your prescreening process and physical distancing.
Reach out to your elderly patients and do a wellness check. They will appreciate the contact.Many of them are isolated and lonely, as well as frightened. Call them on the telephone, don’t rely on emails and text messages because many of them may not have access to technology
Hygienists should call their patients who are in active therapy as a wellness check and to provide advice and support until the patients can return for their appointments. Revitalizing the hygiene columns will be challenging and there are many things to consider such as the use of ultrasonics and the air/water syringe and how much time to allot for hygiene appointments. Scheduling hygiene appointments in the future should include extra time to do an assessment before beginning treatment.
Preparing the Reception Area
1. Disinfect all surfaces in the office including the front desk, telephone, computer, point of sale machine, pens, etc. The Canadian Centre for Occupational Health and Safety recommends that communication devices should not be shared so have disinfecting wipes available at the front desk and wipe down the telephone between users.
2. Thoroughly clean the reception area including the furniture and remember to clean the legs and backs of the chairs. Remove magazines and toys as well as any unnecessary clutter or decorations that could harbour germs. Wipe down all picture frames and clean the windows. This is a great opportunity to do a thorough spring-cleaning.
3. If you have plants in the reception area, thoroughly wipe them down with a damp cloth. Plants are good for air purification and studies have shown that they reduce stress and noise.
4. While your office is closed, it is a great time to do a complete inventory of your supplies. Make sure that you have enough PPEand gowns for when you do open. Check all the expiry dates on products.
5. Order supplies. This is a good time to get the ordering done and you may have to spend extra time shopping around to get what you need. Suppliers will likely be extremely busy filling orders and necessary supplies that are in high demand may be delayed depending on where they are coming from. It’s best to get your necessary orders in early. Try not to over order and remember that everyone is in this together. It is a good idea to check the authenticity of the products that you order and what you receive. There are many grey markets products available, which may not be approved.
6. Restock the operatories. Check all of the surfaces that may require barriers if they cannot be disinfected between patients. Remove as much as possible from countertops and surfaces within 2 meters of potential contact with aerosols.
7. Check all of the equipment to make sure everything is in working order. Now is the time to have any needed repairs done. The dental suppliers are providing checklists that will help you keep your equipment in good working order.
8. Train the receptionist on how to sanitize the work area, how to wear a facemask,(including how to properly doff and don required PPE), how to avoid cross contamination and how to physically distance when checking patients in and out.
Consider a Paperless Environment
If you have been considering going paperless, now is a good time to begin the implementation process. Purchase a high-speed scanner and begin the process of creating e-charts. Scan in all documentation that you need to retain into the patient’s record. Shred any documentation that is not needed following the proper guidelines for recordkeeping. Indicate on the chart that it has been e-charted. Arrange with your software provider training for your staff on how to work in a chartless environment. Most dental software companies have online tutorials or could arrange to train via Zoom.
When it is time to open again – Fitness to Work Policy
Before returning to work, you need to have “Fitness to Work Policy”that will provide you with procedures to follow when bringing your staff back and for the future. Refer to your regulatory body and the Public Health Department for guidance on back to work protocols.
Each employee is responsible for notifying the doctor or his or her designated appointee if they have been in close contact with an individual who is, or is suspected of being, ill with pandemic influenza, (in this case COVID19). A “close contact” is defined as an individual who has cared for or lived with a person known to have an infectious disease or who has a high likelihood of direct contact with respiratory secretions and/or body fluids of a patient known to have an infectious disease. This direct contact would include sharing eating or drinking utensils, and close conversation (within six feet).
If the employee reports illness by phone or email the designated Health and Safety Representative (HSR) or doctor should contact the employee by phone and ask if they are exhibiting any of the symptoms listed on the prescreening assessment.
If the employee’s symptoms do not correspond with those on the assessment, tell them to keep in contact and to contact their physician or Ontario Telehealth Network if needed.
If some or all of the employee’s symptoms correspond with those on the assessment, the HSR or doctorshould:
a) Inform the employee that he or she must stay at home until the symptoms abate.
b) If the employee has been in contact with someone who has tested positive but the employee does not have any symptoms, he/she must self-isolate for 14 days. Advise the employee to immediately contact a health professional by telephone.
c) Complete a brief report noting the employee’s condition and any staff and/or visitors the employee has been in contact with.
d) Arrange for the employee’s work area to be cleaned and disinfected.
If an employee reports to work exhibiting symptoms of illness or exhibits symptoms while on the job:
(a) The employee’s symptoms will be identified by their response to the assessment.
(b) The employee should immediately be provided with an approved surgical mask and should put it on.
(c) The employee should immediately leave work and contact a health professional. The employee should avoid public transport when leaving work.
(d) The employee’s work area should be cleaned and disinfected
(e) All contacts of the employee within your office should be advised that they may have been infected and be asked to go home and await further instructions.
Managing Patient Appointments – Pre-screening Patients
Develop a system of telephone triage to determine the nature of the appointment, whether it is a true emergency or urgent care. Doctors and assistants need to work closely with the administrative team to identify the patients who need to be seen first, following the guidelines from the regulatory bodies.
Below is a sample of Prescreening Assessment Questions that you may wish to consider:
• Have you travelled out of the country in the past 14 days?
• Have you experienced the following within the past three (3) days?
• Sudden onset of respiratory illness (e.g., shortness of breath or difficulty breathing, coughing up bloody
• Fever greater than 38 degrees Celsius?
• Muscle aches or weakness?
Stagger appointment times and try to see patients in every second operatory, if possible, depending on the size of the office. When the patient arrives at the practice, ask the pre-screening questions again, but do not include the question about travel.
Only allow one or two people in the reception area at a time to maintain physical distancing. Have patients wait outside the dental practice, if necessary, (e.g. in their car) before being seen. When an operatory is ready for treatment, call each patient and repeat screening for COVID-19 with temperature recording, prior to allowing entry to the dental practice. Consider purchasing a non-contact infrared thermometer or have the patient take and report their temperature, with their own thermometer, before they arrive at the dental practice. Accompanying individuals should wait outside the dental practice (e.g. in their car), unless absolutely required, such as a parent accompanying a young child or a patient who requires accommodation.
The reception area should be cleaned and disinfected every 30 minutes, or twice per day at the very least.
The Federal Government is providing relief for small businesses that you will be able to take advantage of such as an interest free loan for $40,000.00 with possible forgiveness of $10,000.00 if $30,000.00 is repaid by Dec. 31/2022. They are also providing assistance with rent and wage support that will cover 75% of wages for the employees that you will be recalling to work and, most recently,rent relief assistance of 75%. Take advantage of the assistance that is being provided now as a starting point for full financial recovery.
Looking to the Future – Business Continuity Planning
We have learned a lot from this crisis and that knowledge provides us with an opportunity to be prepared for whatever the future may hold. Protect your business by having policies and procedures in place that enable you to manage the contact, control and monitoring during a pandemic. Pandemic planning policies and procedures are critical components of your health and safety program. It is more important than ever to have protocols and procedures in place which help to protect the health and safety of employees, patients, and the public, to prevent damage to business assets, and to minimize business losses stemming from future unforeseen events, civil emergencies and business interruptions. It is never too late to plan for the future to protect your patients, your practice and your employees. Your Emergency Response Plan will help you to enjoy a robust recovery and be prepared for possible bumps in the road moving forward.
Pandemic COVID 19 Tip Sheets,Canadian Centre for Occupational Health and Safety (CCOHS), 2020. Excerpt reproduced with the permission of CCOHS, 2020
Dental Office Consulting Services, Occupational Health and Safety for Dental Offices, Pandemic Planning