Preadmission Screening for Adults

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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

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Preadmission

• Determines if patient eligible for student clinic
• Reviews clinical policy
• Establishes the patients 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

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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.

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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

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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

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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

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Appointments made in AxiUMElectronic Patient
RecordNew to COD- get T-number until show up
then get a regular number assigned
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Screening patients are appointed

• AM- scheduled at 8 and 830
• PM- scheduled at 1 and 130
• Purposely staggered to help with long lines and
  urgent care patients who often arrive at 730
• Students scheduled at 900 and 200

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Preadmission introduction
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Patient arrives. 1st floor registration
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Fee for Screening is 40 NOT 15 as video from
2001 states
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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 AxiUm patient number.
1C- Preadmission summary form student record
general findings, missing teeth, periodontal
probinggt 5mm, carious lesions Team Leaders or OD
faculty review findings and help determine fee
estimates
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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

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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

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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

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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

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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.

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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

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Team Leader meet and prescribes screening
radiographs usually panoramic and BWs
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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 dont do full mouth radiographic series during
  preadmissions generally

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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.

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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

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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)

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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

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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.

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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

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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

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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.

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Sample weekly schedule
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Receptionists check in patient Name turns red in
Axium and in Scheduler
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Scheduler information- name, gender, age, Axium
number, type of appt, who scheduled, phone
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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)

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Review Panoramic and other films- can mark
missing teeth in Axium HER and/ or1 C
Preadmissions form
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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

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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

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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

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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

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Forms tab in Axium- add form
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Chief Complaint form- when select ADD Chart
form will get drop down menu
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Chief Complaint form
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Medical History Form MEDGPR
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Medical History Positive findings
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• Note medical alerts
• Bottom in RED
• Top under alerts
• COMMENTS ADDED HERE

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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.

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MicroMedEx link
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Take Blood pressure reading

• Record in Axium
• Take pulse- record in Axium
• Bottom of Medical Hx

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Dental History FormNot yet in Axium (will
inquire)Can use paper form until resolved
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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.

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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

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Signatures / Swipes / Approvals
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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)
  

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Hard tissue examination caries, defective
restoration,broken, missing teeth etc under
FINDINGS
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Once review hard tissue can proceed to soft
tissue Periodontal exam and Occlusion

• Will spot probe and mark and probing depths gt
  than
• 5 mm on
• 1C preadmission form.
• ANGIE BAXLEY, RDH can assist you in perio and
  other charting
• Review OCCLUSION

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Previser- Risk assessment tool

• Evidence Based tool
• For assessing risks
• Oral Cancer
• Dental Caries and Tooth Fracture
• Periodontal Disease
• http//www.previser.com/

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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

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Consults at screeningAre General not specific
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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.

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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

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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

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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

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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.

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Complete 1 D form Oral Diagnosis Guide Form

• Will determine which additional radiographs
  needed
• Need for Diagnostic Casts
• Need for additional consults
• Etc.

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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

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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)
• Wont need more than panoramic or BWs
• Can treatment plan same session

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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

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Attach SHAPED note in Axiumto existing SCREENING
CODE
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QUESTIONS