APDCH Patient Care Manual

• Manual for patient care at Adhiparasakthi Dental College and Hospital (APDCH).
• Uniform patient care is guided by written standards, laws, regulations, and guidelines for all APDCH staff in all departments.
• This manual scopes the front office, outpatient, and all patients, including the Medical Records Officer, HIS, and quality coordinators.
• Correspondent, Principal, Department Heads, Doctors, Staff Nurses, QMS coordinator, Front office, IT team share responsibility.

Abbreviations Used

• NABH: National Accreditation Board for Hospitals and Healthcare Providers
• COP: Care of Patients
• APDCH: Adhiparasakthi Dental College and Hospital
• OPD: Outpatient Department
• SOP: Standard Operating Procedure
• UHID: Unique Hospital Identification number
• QMS: Quality Management System
• HIS: Hospital Information System
• DHSP: Dental Health Care Service Provider
• MAPIMS: Melmaruvathur Adhiparasakthi Institute of Medical Sciences

Definitions

• Outpatients defined as patients who visit the hospital for consultation.
• Registration is seeking personal details of individuals seeking dental service.

Policy Guidelines

• Guidelines include emerging human rights for uniform patient care.
• Everyone should be treated with courtesy, consideration, and without discrimination as per national and international laws.
• All patients are treated irrespective of religion, caste, social status, or financial ability.
• Hospital prioritizing the safety for all patients seeking health care as top priority.
• Evidence-based medication is required, prescription based on drugs available in hospital formulary.
• Test dose with observation to be safe before administration of a drug known to produce reaction if administering an injectable drug.
• Medical and life supporting equipment in serviceable condition.
• Staff working in the areas should be familiar with the working of these equipments.
• Supervisors to ensure care provided to all patients given priority attention to the serious category.
• Uniform care to all patients regardless of care settings in OP services.
• Uniform provision of Laboratory, Diagnostics, and Nursing Care services irrespective of category.
• Same quality and protocols of healthcare facility throughout the organization.

Procedures Implemented

• Uniform patient identification using two identifiers.
• Uniform care through written guidance reflecting laws and regulations.
• Evidence and clinical practice guidelines of medicine to guide patient care.
• Uniformity of patient care guided by national/international laws and abides by state/central rules.
• The hospital ensures the same quality of dental care throughout the organization.
• Embraces Diversity, Dignity and Inclusion, with informed consent for special investigations.
• Health is essential with commitment to uniformity according to APDCH - nationally and internationally.
• Uniform identification using UHID, phone number, name and age.
• Best evidence for medical decisions; the collection, interpretation, and integration of patient-reported, clinician-observed, and derived evidence.
• Well-thought-out clinical planning involves clinical expertise and external evidence with sound practices guiding care.

Emergency Services Policy

• Emergency services should be effective, safe, and compliant with legal & regulatory requirements at APDCH.
• Emergency care abbreviation ACLS: Advanced cardiac life support, and BLS: Basic life support.
• Emergency services should be compliant with national/local laws, regulations, and statutes.
• Maintaining written protocols for dental emergencies, staff training, and understanding roles.
• Provision/maintenance of resources like emergency equipment, medications, and trained personnel.
• Check and document emergency resources regularly, providing thorough documentation with patient condition assessments.
• Facility maintains records compliant with facilitates audit and review processes with patient rights and safety prioritized.
• Informed consent should be obtained with information about emergency, proposed treatment, and risks.
• Dental services for medico-legal cases from MAPIMS following statutory requirements per HIS.
• Organized transfer/referral, comprehensive transfer note to healthcare organization with documentation.
• Regularly monitor/audit emergency care/transfer procedures to ensure statutory compliance, adherence to written protocols.

Managing Medical Emergencies and Compromised Patients

• Preventing medical emergencies in the dental chair is paramount
• Referral to specialists with written consent for systemic diseases.
• Aware of risks associated with the disease.
• Blood investigations and pre-arranged crash cart also performed.
• High-risk patients are ideally treated in dental OP MAPIMS.
• Detailed medical history recorded, condition in consent form with prior dental recorded.
• Document previous hospitalization reasons.

Standard Operating Procedures (SOP)

Anaphylaxis

• Assess circulation, airway, breathing, and mental activity, seeking medical help from MAPIMS.
• Administer Adrenalin IM in varying doses based on weight, and reassess blood pressure.
• NS IV (volume expander) given if blood pressure not rising; Inhalational Salbutamol for bronchospasm, then aminophylline 5mg/kg over 30 minutes IV.
• Administer Diphenhydramine 50mg IV if pruritus present.

Cardiac Arrest

• Assess circulation, airway, breathing.
• Start Basic Life Support (BLS)-CPR if no pulse.
• Perform CPR with patient on floor to activate medical response team immediately through Code Blue.
• Administer IV epinephrine 1mg every 3-5 minutes with IV Amiodarone 300mg bolus before help arrives.

Asthmatic Patients

• Upright Position leaning forward and assess circulation
• Administer high conc of oxygen to have PaO2 > 92%; If bronchospasm is present, give inhalational salbutamol then give aminophylline 5mg/kg over 30 minutes IV.
• Call MAPIMS for help with 200mg of Intravenous hydrocortisone given.
• If not relieved, administer salbutamol IV and IV aminophylline 5mg/kg over 20 minutes, with 1mg/kg/hr continuous infusion.

Seizures

• Assess circulation, airway, breathing of the patient in supine position
• Stop all procedures and remove objects while calling for help.
• IV line Established
• Midazolam 1 ml (1 mg)/min OR Diazepam 0.1 – 0.3mg/kg IV. 5.Intravenous Infusion of 25-50 ml of 50% Dextrose
• Phenytoin 15 -25mg/kg loading dose diluted in NS is given slowly iv over 15 minutes, maintenance dose is 5mg/kg in 2 divided doses.

Syncope

• Place patient supine with legs elevated from trendelenburg position
• Assess airway and circulation
• Administer oxygen and use respiratory stimulants
• If bradycardia persists administer atropine 6mg IV.
• If still not responding, support respiration by administering oxygen.

Choking

• Assess airway, breathing and circulation
• Decubitus position to encourage forced cough by doing 5 blow backs or heimlich
• Magill's intubation and cricothyroidotomy used to remove the object.

Managing Diabetic & Hypoglycemic Patients

• Vitals Monitoring of BP and pulse
• Blood sugar (below 200 mg/dl for extraction) and get physician opinion.
• Referred to MAPIMS for written consent and fitness.
• Regular meals should not be skipped.
• Medications advised by physician and early appointment preferred.

Hypertensive Patients Management

• BP controlled to under (systolic 100 to 140mmhg Diastolic 80 to 90 mm/hg)
• Medical fitness and early appointments required

Bleeding Disorders SOP

• Referral to specialist and procedure consent are obtained from treating physician.
• Treatments with transfusion of required Factor VIII by hematologist with OP in MAPIMS.

Anticoagulants/Antiplatelet SOP

• Referral to advice and stop the drug.
• Blood work: BT, CT, PT, PTT and INR ordered with bridging if needed in MAPIMS dental OP.
• Standard preparations for bleed control: Sutures, Abgel, Surgicel.

Liver Disorders SOP

• Identify Signs jaundice, spider naevi, finger clubbing, palmer erythema, sialosis, gynaecomastia.
• Limit drugs erythromycin, metronidazole and tetracycline with no aspirin and NSAIDs due to risk of hematostatis/hemorrhage.

Acute Adrenal Insufficiency management

• Terminate treatment, supine position elevated and [BLS] support.
• Care: Monitor vital signs, assistance, Gluccocorticosteroids and BLS with IV as needed.
• Transfer to hospital.

Hypoglycemia Management

• Give 15-20g of fast-acting carbohydrates
• Administer glucagon if unconscious or call service if severe.
• Document the incident and recommend follow-up.

Hyperventilation Management

• Recognition of rapid breathing, dizziness, and tingling in extremities.
• Stop dental procedure.
• Have the patient breathe into a paper bag
• Document the incident and advise follow-up if necessary.

Thyroid Disorders Management

• Medical referral and evaluation is required, for thyroid are in normal range.
• Monitor fever, abdominal pain
• Assess with activation and feet elevated.

Endocarditis Management

• Prophylaxis only if cardiac conditions are present.
• Procedures that needs manipulation of gingival tissue and mucosa.
• Procedures includes anaesthetic injection or placements

Antibiotics Regimens

• Amoxicillin can be used
• Clindamycin or Cephalexin are used for allergic patients.

Medical Legal Case of Transfer and Referral for Emergency to MAPIMS

• The facility adheres to statutory dental services and legal obligations.
• For transfer clinical evaluation and documentation are to be completed.
• Preparation of note includes: Identification, Condition Summary, Reason, Contact, and Transfer
• Patient family will be informed of the transfer
• The facility is informed with relevant patient and acceptance
• Transport by MAPIMS
• All document all processes documented during service.

Cardio Pulmonary Arrest

• Emergency is to be responded with BLS/ACLS Resuscitation
• Code Blue with AHA Emergency
• Health care are to be trained and equipped to CPR
• Resuscitation Drills audited
• Medications and equipment for emergency

Code Blue Team

• The team includes the correspondent, Nabh coordinator, Periodontist, Surgeon, etc
• They are required to analyze the code
• Reuscitation are in stations
• Staff to be aware of precaution

The organization supports paediatric and emergency measures

The code "Pink" has now been given for the procedure of child alert

• Used if the confirmed abduction is confirmed
• Immediate Notification to staff who see it happen
• Team is deployed

Protocol to ensure a safe practice of Child Abuse Reporting

• Ensure effective response is activated
• Doctors to staff are to contact supervisor and call line 111
• If response team is to be dispatched remove patient

Vulnerable patient procedures

• Patient should be old, children, Anesthesia, pregnant, chemotherapy
• Staff to be trained for this type of care
• 7.3 Org must identify those at risk fo falls
• 7.4 Org must identify those who need to have restraints
• Vunerable patients needs to have a companion
• Female patients are to have an attendee
• Patients who are high risk are flagged

Managing pregnant patients

• Procedures need to be done after consulting Gynecologists
• A and B drugs needs to be prescribed Elective surgical procedures if absolutely indicated will be performed in the second trimester after obstetrician fitness for the procedure.
• Supine needs to be avoided

Risk assessment for falls

• Assessment through Tinetttie Balance Assessment Tool.
• Assess and create plan and follow up.

Restraint procedure

• All steps need to be documented and consents.
• To be applied by trained professionals

Surgery procedures and responsibility

Surgical procedures and competency levels: All minor surgical procedures shall be undertaken by the specialized surgeons or under their supervision by the training doctors as per the list of surgical procedures included in the scope of each department.

• icheklists to be used and quality programs to be enforced.
• All events should be monitored and a staff should be appointed to collect data.
• Sterility to be monitored every month.
• Theatre needs to have facilities.
• all instruments should be sterile.

Patient assessment

• Assessment through ANA
• Pain assessment is key through various visual cues

Mitigation

• Involve family when possible Involve family when necessary. The patient should only be observed untill their initial functions are restored.