On April 27, 2020, the Governor announced the schedule for businesses to return to operations to include the re-opening of dental practices for all dental procedures effective May 1. The return to practice includes strict adherence to Ohio Administrative Code provisions set forth in 4715-20 with respect to patient and personnel protection as well as sterilization and disinfection. However, the Board has also directed dental practices to follow the guidelines below:
- Pre-screen every patient for COVID-19 risk factors using a comprehensive questionnaire until accurate testing is available.
- Reduce the number of in-person appointments by utilizing telephone triage and other remote strategies to address specific patient concerns.
- Stagger patient appointments to minimize patient-to-patient contact. To facilitate adequate distancing, it is strongly recommended to limit one patient per dental care provider. Observing these guidelines will regulate the number of patients within an office/clinic at any given time.
- Social distancing will be observed in the dental offices and waiting areas. To help adequate distancing, it is strongly recommended to limit one patient per dental care provider. Observing these guidelines will regulate the total number of patients seen in a day and the number of patients within an office/clinic at any given time.
- Schedule patients ensuring that sufficient time is allocated for appropriate disinfection between patients as recommended in the ADA toolkit.
- Patients should come alone for appointments (except where necessary for interpreters, guardians of minors, and others needing assistance).
- Record body temperatures for every patient when they arrive for their appointment.
- Patients reporting or exhibiting COVID-19 symptoms are to be advised to contact their primary care physician immediately and placed in quarantine as appropriate. See updated CDC symptoms list: https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html
- Dentists should secure COVID-19 test reports where available for patients and staff.
- All staff members should have their temperatures taken upon arriving at work and a record maintained at the dental office.
- Staff members who report or exhibit any COVID-19 symptoms should self-quarantine and contact their primary care physician immediately and follow their advice. If found to be positive, the dental office should follow the Ohio Department of Health protocol.
- All dental personnel shall use appropriate PPE as dictated by the procedure performed, consistent with guidelines from the CDC and the American Dental Association, including masks, face shields, fluid-resistant gowns and hair cover if applicable.
- Dental providers should use high volume evacuators and isolation strategies including rubber dams when appropriate to limit exposure to aerosols.
- It is recommended that patients use a pre-procedure mouth rinse immediately before beginning a procedure.
- All surfaces must be disinfected between patients in accordance with the ADA guidelines.
- Special care should be taken for patients with higher risk (pre-existing comorbidities) or immunocompromised individuals.
- Dentists are encouraged to work with local public health agencies regarding necessary screening and reporting requirements.
In addition, dental practices are encouraged to follow CDC and ADA recommendations and guidelines which can be found at the links below.
- CDC: https://www.cdc.gov/oralhealth/infectioncontrol/statement-COVID.html
- ADA: https://success.ada.org/~/media/CPS/Files/COVID/ADA_Interim_Mask_and_Face_Shield_Guidelines.pdf
Risk Management Recommendations
The requirements and recommendations of the State Dental Board, CDC and the ADA will offer great protection for dentists, staff and patients from COVID-19 infection. However, what is not widely discussed is what will protect the dental practice from COVID-19 related claims. Such claims can come in the form of malpractice claims by patients who allege that they contracted COVID-19 from the practice or employment claims from employees who allege that they contracted COVID-19 in the workplace.
As with any legal claim, the best defense is documentation. In light of the challenges presented with COVID-19 and the enhanced guidelines of regulatory boards and agencies to combat the pandemic, documenting the steps taken by your practice to prevent the spread is critical.
Include in the Patient Chart:
- Detailed pre-screening of patient relative to known risk factors and symptoms;
- Update of the patient’s medical history to include identification of any comorbidities that would put the patient in a high risk group;
- Patient’s temperature and physical presentation upon arrival;
- Notation in the chart as to any patient with an elevated temperature or COVID-19 symptoms were referred to their physician and recommended quarantine;
- Whether the patient or a patient’s family member has tested positive and when;
- Who accompanied the patient, if any, to the appointment;
- Confirmation that appropriate PPE was utilized at all times during treatment; and
- All staff members present in the operatory during treatment (initials).
- Prior to re-opening the practice, have each staff member document whether they or another person within their household has tested positive and, if so, confirmation that the appropriate quarantine guidelines had been followed and completed;
- Notice to patients regarding social distancing and use of masks as mandatory while awaiting treatment;
- Disinfection log for each operatory confirming appropriate disinfection between patients and the time of each disinfection following recommended by the ADA guidelines;
- Daily record of all staff members’ temperatures;
- Any staff member who has elevated temperature and/or reports COVID-19 symptoms, as defined by the CDC, should document all patients and staff with whom they had contact;
- For all symptomatic staff, confirmation that Ohio Department of Health protocols were then followed; and
- Documentation signed by each employee, to be placed in that employee’s file, confirming that they:
- Have been provided with and understand all requirements set forth by the State Dental Board and the CDC relative to sterilization, disinfection and PPE.
- The employee understands that he/she has an obligation to provide notice to the practice in the event that there is a shortage of necessary PPE or, if necessary equipment or materials are not available for compliance with regulatory requirements or guidelines.
The above documentation are suggestions and are not exhaustive. While there is nothing that can prevent a complaint to the State Dental Board or the filing of a malpractice claim, following the regulatory requirements and properly documenting the patient chart and the activities of the practice will significantly enhance your ability to defend such complaints.
Should you have any questions or concerns, do not hesitate to contact an attorney at Mazanec, Raskin & Ryder for guidance and assistance.