Service Overload A Triage Model from a Northern Ireland Prison

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Service Overload? - A Triage Model from a
Northern IrelandPrison

• Dr Ruth Gray
• Ms Trudi Fawcett
• dental_at_ruthgray.com

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Demand Greater Than Supply
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Prison Setting Hydebank Wood

• Young Offenders- Males 16-21
• Female Prison
• Population 250 approx
• Total Commitals 1500

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Prison Population

• Young and Male
• Low Levels of Literacy
• Early School Leaving
• High Unemployment
• Low Socio-Economic Status
• High Level of
• Re-offending

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General Health of Prisoners

• High prevalence of infectious diseases
• High levels of chronic diseases
• Alcohol and Substance Misuse
• Mental Health Problems
• Increased Demand and Utilization of Services
• (Lunn 2003, McCall 2004, McGrath 2002, Philpot
  2004)

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Oral Health Survey YOC 2007

• High Prevalence of Dental Caries and Periodontal
  Disease
• Poor Oral Health and Dietary Habits
• Access to Dental Service Difficult
• Little Information about Available Health
  Services
• Minimal General or Dental Health Advice
• Participants Interested in Dental Care

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Prison Structure

• Committal Practice
• Sentencing
• Landings
• Cells
• Lock-up times
• Prisoner Movement
• Escorts

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Referrals

• Triage and Referral Protocols
• Oral Health Assessment Tools
• NHS Emergency
• Marie Curie Cancer Centre
• BSDH
• Scottish Dental Protocol
• Prison Triage Study

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Triage Protocol Hydebank Wood

• 3 Strands
• Oral Health Assessment - Conducted by Dental
  Nurse During Prisoner Induction
• Prioritization of Referrals from Prison Landing
  Staff
• Monthly Clinics for Prioritizing Treatment Need.

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Triage at Induction

• Triage Pro-Forma
• All New Prisoners Categorized for Dental Need
• -Emergency Care
• -Urgent Care
• -Routine Care
• -No Treatment Need, 6 month review

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The Aims of the Triage

• The dental service will be targeted to those who
  need it most clinically, rather than being
  demanded by individuals.
• To prioritise patients in pain.
• To maximise the efficiency of clinical sessions.
• To use triage time as an opportunity for Oral
  health education.
• To support the Healthcare nursing staff during
  induction process.
• To integrate the dental team into the wider
  multidisciplinary healthcare team.

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Triage Process

• Patients are seen 72 hours post committal for a
  general health assessment.
• At this time patients are seen individually for
  oral health assessment by Dental Nurse.
• Oral Health education included.
• Patients are categorised according to clinical
  need.
• Appointment booked according to timeframe.
• Patient seen by Dentist for examination.

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Using the Oral Health Assessment Tool

• The information gathered using the algorithm
  allows me to put patients into 4 categories
• Emergency
• Urgent
• Routine
• Dental check up

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Following Algorithm

• Dental Nurse to establish patient awareness of
  oral health and their expectations.
• Dental Nurse asks if any problems, and they are
  cited and circled. Space to expand on info.
• To ascertain the patients past dental
  attendance/motivation
• Medical History/conditions and medications may
  highlight and special dental attention needed.
• Check social/ smoking status, alcohol, substance
  misuse.

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Oral Health Education

• This time spent with the patient on an individual
  basis allows Oral health education as well as
  Oral health assessment
• Power point devised by Dental Nurse which covers
• Diet
• Substance misuse and affects on Oral health.
• Smoking cessation (opportunistic brief
  intervention)
• Importance of regular dental attendance.

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Induction Presentation

• Introduction to the healthcare team
• What services are available, and how to access
  them - Dental , Optician, Podiatry, Mental health
  support, Sexual health, Sleep hygiene clinic.
• Discussion about patient confidentiality.
• Patients right to complain, and how to make a
  complaint.

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Barriers to Triage

• Occasional lack of support from some healthcare
  staff.
• No designated hospital escort.
• General clinical interruptions.
• Industrial action of Prison Officers work to
  rule.
• Security incidents which affect the smooth
  running of most Prison activities.

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Dental Nurse Observations

• Patients feel reassured that someone is taking
  them seriously.
• Patients feel that they wont get lost in the
  system.
• Triage time is an opportunity for patients to
  meet dental staff and discuss fears they may
  have.
• Triage puts dentistry at the front of the
  patients mind, as many are non attendees.

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Oral Health Problems
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Other Results

• 50 Attended Dentist in Last Year
• 26 Treatment with Sedation
• 84 Smoke
• 71 Alcohol
• 74 Substance Misuse- cannabis, cocaine,
  ecstasy
• 25 Interested in Interventions

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Triage Category
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Patient Seen on Appointment Date

• 72 Seen on Time
• Non-Attendance
• Visitation
• Pt Refused
• Pt Released
• Lock-Down
• Surgery Renovations

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Dental Examination and Triage Evaluation

• Dentist Examined Each Triage Participant
• 95 of Triage concurred with dental exam for
  patient prioritization.

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Benefits Of Triage

• Targeted Approach to Dental Provision
• Information to Accessing Care
• Interdisciplinary Approach to Service Provision
• General Health Induction
• Oral Health Promotion
• Great Team Approach to Dentistry
• Patient Centred Dentistry

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