Have you heard the phrase ‘If you didn’t write it down, it didn’t happen’? It’s a great concept to consider how to properly document what occurred during a procedure in the clinical notes. Did you take x-rays, perform complete perio charting, use nitrous? Since your clinical notes are deemed to be the legal document of your patients’ chart, it is imperative that all the details need to be thorough and accurate. There is never a question about what exactly transpired in the chair.
For years, our articles constantly beat the drum of written protocols. These are your rules of your practice that all employees are required to follow – benefits, PTO, holidays, the regulations that are followed by governing units, etc. How have your protocols changed in the past 3 months? Probably more ways than you can count. Your check-in process may now include:
the patient texts when they arrive in the parking lot
office calls the patient to ask pre-screening questions
office texts back when ready for patient to enter the building, reminding patient to wear mask while inside
patient’s temperature is taken – recorded (where) and patient signs COVID consent
This is a change in your protocol and needs to be written down.
It might be advisable to add a COVID section in your office protocol book. This area would include the additional PPE that the office staff wears, changes in the methods of sterilizing the office, changes in confirmations, consents and what the patient is expected to do during this time.
I wouldn’t change the entire check-in process of your current protocol manual because it might not always be this way; however, it is important to formally document the changes as they are performed today. Thus, having a COVID section is perfect for this time period in our world. You may ask why take the time to do this if it may not be forever? Because it is your process, your system and by formally documenting it the entire team will have the ‘rules’ by which your practice operates TODAY. In the event that you have new team members, or a temporary worker, there is documentation to explain your systems. Additionally, if an outside source were to question your efforts to protect your patients and your team, you have an official, written proclamation of your mode of operation.
To take this thought process one step further, I suggest a thorough review of the office manual. Are there things that are occurring that are against how your manual currently reads? Again, I would suggest a COVID-19 section in the manual. Are you allowing employees to roll-over PTO when it says in the manual that it isn’t allowed? In this section, you may refer to this policy in this way:
COVID-19 Vacation Accrual Policy
Due to the COVID-19 pandemic, many employees have been unable to utilize their accrued vacation leave as usual. In an effort to support employees and prevent them from forfeiting or losing unused accrued vacation leave effective January 1, 2020, (company name) is temporarily implementing the COVID-19 Vacation Accrual Policy.
Effective immediately and continuing through June 30, 2021, (company name) is suspending the maximum annual vacation accrual caps set forth in the (company name) office manual. Accordingly, employees will not be capped with respect to the maximum amount of vacation leave they may carry forward on December 31, 2020. Rather, they will be given extra time to use such leave.
This temporary policy will terminate effective June 30, 2021, at which time the maximum annual vacation accrual caps will take effect as stated in the (company name) office manual.
You team is required to modify the use of PPE. It is affecting each and every team member. You may want to include a policy in the COVID section of your manual to read:
Personal Protection Equipment (PPE) in the Workplace
Due to the COVID-19 pandemic, it has been suggested that all dental offices utilize specific strategies to help protect employees with additional barriers from the virus. Based on the recommendations of the American Dental Association (ADA), OSHA & CDC, (company name) will implement the following PPE requirements for all employees while in the practice.
Front Desk
Front desk staff will wear masks &/or face shields. The office has installed a clear barrier for additional protection. Inform all patients to remain behind the barrier.
Individual phone headsets are available for each front desk staffer to reduce virus spread through the phone hand piece.
Clinical team
Scrubs are to be changed between street clothes and scrubs upon entry and exit, & do the same with other office garb.
Disposable gowns should be worn over scrubs and removed when entering break room or restroom.
Cloth gowns should be laundered after each use.
Long sleeved garments should be worn at all times
Staff will wear masks &/or face shields
The use of disposable head covers.
Continue use of pre-COVID-19 OSHA PPE (gloves, sterilization, etc)
Hand sanitizer will be available throughout the workplace and all employees are encouraged to use it often throughout the day along with frequent use of soap and water for washing hands.
Probably the most confusing and ever-changing element of this entire event that we are experiencing is the screening of employees and subsequently what happens with positive results. One day the CDC announces that asymptomatic people can spread the virus then it gets replaced with the assurance that asymptomatic people cannot spread it and then that component was converted back to the original assertion. This policy may continue to be amended several times, however, it is important that it is listed to protect the employees, the employer and the business. It is your policy to refer to if there is ever a question of your efforts as well as to train new or temporary team members. A sample of this policy may be:
COVID-19 Employee Screening
(Company name) will implement a daily health screening check point and log for all employees entering the workplace. Upon entering the workplace at the beginning of the day and after lunch, employee temperature will be taken and logged.
Employees with temperature of 100.4 will be sent home, per CDC recommendations.
Additionally, the following questions will be asked:
Do you have any of the following?
Symptoms of acute respiratory illness
Shortness of breath (not severe)
Cough
Persons who are well but who have a sick family member at home with COVID-19 should notify their supervisor.
What if an employee is diagnosed with COVID-19?
The diagnosed employee is informed to not return to the workplace and seeks appropriate medical care.
If an employee is confirmed to have COVID-19, the employer will inform fellow employees of their possible exposure to COVID-19 in the workplace but maintain confidentiality.
Implement deep cleaning and sanitation measures recommended by the CDC and your local health department.
For Anyone Who Has Been Around a Person with COVID-19
It is important to remember that anyone who has close contact with someone with COVID-19 should stay home for 14 days after exposure based on the time it takes to develop illness.
Close contact is defined as:
Spending prolonged periods of time in the same room
Direct physical contact – kissing, hugging
Sharing of eating or drinking utensils
Contact with respiratory secretions (cough, sneeze on you)
Other definitions to know:
Self-Quarantine:
Stay home for 14 days
Avoid contact with other people
Don’t share household items
Self-Monitor:
Be alert for symptoms of COVID-19, especially a dry cough or shortness of breath
Take temperature morning & night and document results
Call your doctor if you have trouble breathing or a fever of 100.4+
Don’t seek medical treatment without calling first
Practice Physical Distancing:
Stay home as much as possible
Don’t physically get close to people
Try to stay 6 feet away
Don’t hug or shake hands
(Company name) will follow the CDC’s recommendations in the following situations:
An employee who is tested positive for COVID-19 but had no symptoms
The employee will stay away from others until:
10 days have passed since test
Has had two negative test results in a row, at least 24 hours apart.
Symptoms of COVID-19 either suspected or confirmed through testing
Employee is excluded from work until:
At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (e.g., cough, shortness of breath); and,
At least 10 days have passed since symptoms first appeared
Has had two negative test results in a row, at least 24 hours apart.
Our world is ever-changing during this and so are the guidelines from the CDC, ADA and OSHA. Documenting what is allowed in your practice is more important than ever to protect your assets. This will require constant monitoring of the recommendations from the governing entities and modifying your written protocols. Although you may continue to verbally review the revising of your processes, it is just as vital to write it down. After all, if it isn’t written down… it didn’t happen.
Denise Ciardello, Consultant
Denise is co-founder of Global Team Solutions. A professional speaker and published author, her enthusiasm and knowledge about the dental profession has helped many dental teams. She brings experience, insight, and creativity into her management style, along with a sense of humor. In a profession that can cause anxiety in some dental employees, Denise’s consulting approach is to partner with doctors and team members to help them realize the dream of creating a thriving, successful practice.
Denise can be reached at: denise@gtsgurus.com