Preadmission / Screening for Adults

1. 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

2. Preadmission • Determines if patient eligible for student clinic • Reviews clinical policy • Establishes the patient’s 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

3. 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.

4. 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

5. 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

6. 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

7. Appointments made in AxiUMElectronic Patient RecordNew to COD- get T-number until show up then get a regular number assigned

8. Screening patients are appointed • AM- scheduled at 8 and 8:30 • PM- scheduled at 1 and 1:30 Purposely staggered to help with long lines and urgent care patients who often arrive at 7:30 • Students scheduled at 9:00 and 2:00

9. Preadmission introduction

10. Patient arrives…. 1st floor registration

11. Fee for Screening is $ 40 NOT $15 as video from 2001 states

12. 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 AxiUmpatient number. 1C- Preadmission summary form student record general findings, missing teeth, periodontal probing> 5mm, carious lesions Team Leaders or OD faculty review findings and help determine fee estimates

13. 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

14. 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

15. 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;

16. 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;

17. 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.

18. 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

19. Team Leader meet and prescribes screening radiographs usually panoramic and BW’s

20. 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 don’t do full mouth radiographic series during preadmissions generally

21. 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.

22. 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

23. 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)

24. 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

25. 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.

26. 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

27. 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

28. 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.

29. Sample weekly schedule

30. Receptionists check in patientName turns red in Axium and in Scheduler

31. Scheduler information- name, gender, age, Axium number, type of appt, who scheduled, phone #

32. 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)

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

34. 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

35. 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

36. 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

37. 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

38. Forms tab in Axium- add form

39. Chief Complaint form- when select ADD Chart form will get drop down menu

40. Chief Complaint form

41. Medical History Form= MEDGPR

42. Medical History Positive findings

43. Note medical alerts • Bottom in RED • Top under alerts • COMMENTS ADDED HERE

44. 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.

45. MicroMedEx link

46. Take Blood pressure reading • Record in Axium • Take pulse- record in Axium • Bottom of Medical Hx

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

48. 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.

49. 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

50. Signatures / Swipes / Approvals