Transcript COLLEGE OF DENTAL HYGIENISTS OF MANITOBA

ME Wener, CDHM AGM, Sept 08
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CDHA web photo
THE EXTENDED PRACTICE RDH
COLLEGE OF DENTAL HYGIENISTS OF MANITOBA
AGM Sept 27, 2008
Mickey Emmons Wener RDH, MEd, CDHM-TC Chair
Today
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The Dental Hygiene Process of Care
RDH services and supervision
Requirements of the Extended Practice RDH
Extended Practice in:
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Private practice
Clients’ homes
Personal care homes (PCH) & hospitals
Oral health programs
Other settings
Next steps…
ME Wener, CDHM AGM, Sept 08
RDHs are:
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Regulated primary oral health care
professionals who specialize in services
related to clinical therapy, oral health
education and health promotion.
ME Wener, CDHM AGM, Sept 08
Dental Hygiene Process of Care
CDHM Practice Standards & 183 Competencies!
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Assessment – 67 competencies
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Planning – 24 competencies
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Develop a DH care plan with the client
Implementation – 72 competencies
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Gather objective and subjective data
Analyze data to develop a DH diagnosis within the RDH’s scope of
practice
Provide care within the RDH’s scope of practice
Evaluation – 20 competencies
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Evaluate effectiveness of care
COLLABORATION
with other health professionals is of the utmost importance!
ME Wener, CDHM AGM, Sept 08
‘Low risk of harm’ services:
No supervision requirements for any RDH
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Oral chemotherapeutic agents
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Sealants
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‘Applying dental sealants where after an assessment of the tooth, the dental
hygienist determines that there is no obvious sign of decay’
Other examples:
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Anticariogenic, desensitizing, periodontal chemotherapeutic agents
Others as approved by the CDHM Council
Assessment, planning & evaluation
Oral health promotion and education
Impressions, study models & mouthguards (NOT nightguards)
Examples of their application
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Custom mouthguard clinics for sports teams
Prevention for high risk children
Oral cancer screening clinic – intra/extra oral exam
ME Wener, CDHM AGM, Sept 08
Always provided with a dentist
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Restorative procedures
 Placement
of amalgams, composites
www.ada.org
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Orthodontic procedures
www.prevention.com
ME Wener, CDHM AGM, Sept 08
The Extended Practice RDH Promotes:
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Access to care in a variety of settings
Autonomy
Collaboration
OPPORTUNITY!
ME Wener, CDHM AGM, Sept 08
The Extended Practice RDH
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An experienced RDH
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Applies to higher risk procedures
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3000 career hours of practice
Scaling, root planing, debridement, local anesthesia
Higher risk procedures have setting requirements
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Dentist’s office or a setting approved by the patient’s dentist
Designated long-term care, hospital and psychiatric facilities
An oral health program established or operated by:
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the government of Manitoba or Canada
a municipality
a regional health authority
the University of Manitoba
Facilities or programs approved by the Minister of Health
ME Wener, CDHM AGM, Sept 08
Collaboration & Consultation for Client Safety
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After reviewing the patient’s health record the
RDH-EP determines that:
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a) A patient does not have any MEDICAL or ORAL HEALTH CONDITION
that may significantly affect the appropriateness, efficacy or safety of
the procedure.
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If there is a medical or oral condition that may affect the
appropriateness or safety of a procedure, the dental hygienist must only
perform the procedure after consulting with a dentist or physician,
Registered Nurse Extended Practice or Certified (Medical) Assistant, as
appropriate.
b) A patient is not on a DRUG or COMBINATION OF DRUGS that the
dental hygienist is unfamiliar with or which could affect the
appropriateness, efficacy or safety of the procedure.
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If the patient is on a drug or combination of drugs that may affect the
appropriateness, efficacy or safety of the procedure, the dental
hygienist must only perform the procedure after consulting with a dentist,
physician, or pharmacist as appropriate.
ME Wener, CDHM AGM, Sept 08
What does ‘No Supervision’ for RDH-EP mean?
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RDH can SELF-INITIATE care
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RDH can do initial assessment, formulate DH
diagnosis and proceed with care.
Client may be seen with or without:
 having been previously seen by the dentist
 the dentist on site at the time of the
appointment
 seeing the dentist at any time after the
appointment
ME Wener, CDHM AGM, Sept 08
How does this work in private practice?
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OPTIONS: In dental office, without dentist present
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RDH & dentist select existing clients appropriate to be seen
for recall when dentist is not present - 1 hour, day, week…
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RDH sees new client for assessment, DH diagnosis & plan of
care (med history/drugs clear), proceeds with tx
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RDH could be on contract (self-employed) with a dentist as
an associate, whereby billings could be completed through
the dentist or the dental hygienist
ME Wener, CDHM AGM, Sept 08
Can I provide care in someone’s home?
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The client/patient is an existing patient of a dentist
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The client/patient is accessed via a governmental agency
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Of a practice you are employed in
Of several practices you have established an affiliation with
Patients are referred back to the dentist for any further needs, or to another provider
of the dentist’s and patient’s choosing
RDH establishes working relationship with an entity such as Manitoba's home care
program, or any government agency providing care in the home
Work with CDHM to establish groundwork to ensure success for yourself and others
The RDH cannot:
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Start a home care business that is solely being operated by the RDH with no affiliation with
a dentist or an approved/government agency
Directly advertise to the public that you can be contracted independently for this service
ME Wener, CDHM AGM, Sept 08
What about working in LTC or a hospital?
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RDH services particularly suited to a PCH or hospital setting:
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initial oral assessment (assessment/referral, oral cancer screening)
periodontal therapy (cleaning and debridement)
individualized daily oral care plans including product selection
on-unit assistance
health promotion such as caregiver in-services, family education, and
oral care policy consultation
Requires consent/working relationship with:
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the facility
the unit/ward
the individual/family/guardian
OPPORTUNITY:
RDH for Central Regional Health Authority, McGregor & District Health
CDHM of
AGM,
Sept 08
Centre to do initial oral assessmentsME
onWener,
admission
residents
Referring in LTC
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For oral health issues beyond dental hygiene care,
the dental hygienist must alert:
 the resident or their guardian/legally accepted representative (LAR)
 the staff/facility
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And, advocate for/refer the resident to:
 the family's preferred dentist
 a dentist working with the facility (i.e. CCOH's mobile van services)
 a dentist near the facility, or
 another suitable arrangement
ME Wener, CDHM AGM, Sept 08
Could I work in a community-based
health clinic without a dentist?
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Yes, if:
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the clinic is in one of the approved settings or programs
approval is sought & granted from the Minister of Health
What might I do?
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Work within existing programs with other health professionals
Establish a new oral health promotion program
Provide on-site clinical care
Do home visits for infants/toddlers or older adults
Refer those who need dental care beyond RDH scope
ME Wener, CDHM AGM, Sept 08
Dental Hygienist Act Increases
Access to Care in PCH’s and Hospitals
(news item on CDHM web site)
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Communiqué from the College of Dental Hygienists of Manitoba
Dental Hygienist Act Increases Access to Care in PCH’s and Hospitals
Registered Dental Hygienists (RDHs) are regulated health care professionals who specialize in services related
to oral health care, education and promotion. Preventive oral care is taking on an increasingly important
role as serious health issues such as aspiration pneumonia, diabetes and cardiovascular disease have been
associated with poor oral health and inadequate daily mouth care. Dental hygienists are in a unique position
to help address these health issues in personal care homes and hospitals.
Within a PCH or hospital setting, the new Extended Practice RDH is able to provide services as a collaborative
primary health care provider working without a dentist’s supervision. RDH services particularly suited to a
PCH or hospital setting include: initial oral assessment (assessment/referral, oral cancer screening),
periodontal therapy (cleaning and debridement), individualized daily oral care plans for residents/patients
including product selection, on-unit assistance, and health promotion programming and delivery such as
caregiver in-services, family education, and oral care policy consultation.
In accordance with the CDHM’s practice standards and competencies, the Extended Practice dental hygienist
completes a review of the medical/dental history, an intra/extra oral assessment and the dental hygiene
care plan, prior to proceeding with clinical care. Where there exists a potential contraindication to
treatment, the dental hygienist is required to consult with the appropriate health care professional. For
residents/patients with oral health issues requiring attention that are beyond the scope of the RDH, the
dental hygienist would alert the resident or their guardian, the staff/facility and then advocate for dental
treatment.
Research increasingly shows that oral health is an indicator of overall health and
this legislation means increased access to oral health care for more people.
Theresa Oswald, Minister of Health, News Release-excerpt, April 2008
ME Wener, CDHM AGM, Sept 08
Other Settings:
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Government
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Municipality
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Manitoba - Regional Health Authorities
Canada - First Nations and Inuit Health Branch
An RDH-EP could become affiliated with or initiate a clinic/oral health
program in conjunction with a municipality, i.e. ‘City of _________’
University of Manitoba
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Students can be supervised by an RDH-EP in any
U of M program/clinic
ME Wener, CDHM AGM, Sept 08
How does a non-approved setting get
approval from the Minister of Health?
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Consult with CDHM
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Submit letter to Minister of Health & CDHM
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Does setting require approval?
Has it been previously requested?
Describe setting
Explain dental hygiene’s role
Provide rationale for how providing care
within this setting will contribute to the public’s
oral health
Example to date
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Siloam Mission
ME Wener, CDHM AGM, Sept 08
Getting ready to transition…
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Preparation and support
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CDHA courses
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DECOD University of Washington self-study (Dental Education in the Care of Persons
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U of M – DH supervised clinical externships, portable equipment
MB study group for those interested?
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Self-initiation for Dental Hygienists
Certificate Program: Independent Practice for Dental Hygienists
with Disabilities) program http://www.dental.washington.edu/disability/
Reimbursement
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Salaried position
Fee-for-service
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Traditional payment
RDH direct billing to plans; see CDHA web site;
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Must reside in a jurisdiction where it is legal
Must use CDHA National List of Service Codes© for RDHs
Plan must be approved for RDH billing
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CDHM & MDHA co-investigating
ME Wener, CDHM AGM, Sept 08
Proceed slowly, do your homework, investigate,
work with the CDHM
EXPLORE POSSIBILITIES!!!
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Please share your
questions & comments with us!
Keep abreast by regularly
checking the CDHM web site
www.cdhm.info
ME Wener, CDHM AGM, Sept 08