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Patient Safety and Law
Beyond clinical skill, a dental assistant works inside a framework of federal guidelines, privacy law, state practice acts, and emergency preparedness. This chapter covers the CDC recommendations for dental settings, HIPAA, records and consent, scope of practice, medical emergencies, and hazard communication.
CDC Guidelines and Practice Policy
The CDC publishes the national recommendations that shape infection prevention policy in dental offices, and state boards and OSHA inspectors both look to them. A practice turns those recommendations into written policies, assigns someone to oversee them, and trains the team.
Written infection prevention program
Every dental setting should have written infection prevention policies and procedures tailored to the practice, reviewed at least annually.
CDC Summary of Infection Prevention Practices in Dental SettingsAssigned coordinator
At least one trained person should be assigned responsibility for the infection prevention program, including policy updates and staff education.
Training requirements
Provide bloodborne pathogen training at initial assignment and at least annually thereafter, during working hours and at no cost to the employee.
OSHA 29 CFR 1910.1030Employee medical records
Keep confidential employee records covering hepatitis B vaccination status, exposure incidents, and follow-up for the duration of employment plus thirty years.
OSHA 29 CFR 1910.1020Dental unit water quality
Follow the equipment manufacturer's instructions for treating and testing dental unit water, since the program only works if it is monitored, not just installed.
CDC Summary of Infection Prevention Practices in Dental SettingsHIPAA and Patient Privacy
Health information belongs to the patient, and federal law limits who may see it and how it must be protected. A dental assistant handles protected health information all day, in charts, on screens, at the front desk, and on the phone.
Protected health information
Any health information tied to an identifier such as name, address, birth date, phone number, or account number is protected and may not be disclosed without authorization.
HIPAA Privacy Rule, 45 CFR Part 164Treatment, payment, operations
Information may be used without separate patient authorization for treatment, payment, and health care operations, but other disclosures generally require written authorization.
HIPAA Privacy Rule, 45 CFR Part 164Minimum necessary
Share only the smallest amount of information needed to accomplish the purpose, and limit staff access to what each role requires.
HIPAA Privacy Rule, 45 CFR Part 164Notice of privacy practices
Give each patient the practice's notice of privacy practices and obtain written acknowledgment of receipt.
Everyday safeguards
Angle monitors away from the reception area, do not discuss patients in hallways or elevators, log out of workstations, and never post patient photos or details on social media.
Electronic security
Electronic health information requires access controls, unique user logins, and encryption or equivalent safeguards.
HIPAA Security Rule, 45 CFR Part 164Records, Consent, and Medical History
The dental record is both a clinical tool and a legal document, and it is often the only evidence of what was explained and what was done. A thorough medical history review before every appointment prevents most treatment complications.
Record entries
Write entries in ink or in the electronic record promptly and objectively, never erase or delete; correct an error with a single line through it, the correction, the date, and initials.
Informed consent
Valid consent requires explaining the diagnosis, the proposed treatment, the risks and benefits, reasonable alternatives, and the consequences of declining, in language the patient understands.
Who may consent
Consent must come from the patient if an adult with capacity, or from a parent or legal guardian for a minor, and the assistant witnesses rather than obtains consent.
Medical history updates
Review and update the health history at every visit, including new medications, recent hospitalizations, allergies, and pregnancy status, and have the dentist review any change.
Vital signs and red flags
Record baseline vital signs and flag conditions that alter treatment, such as anticoagulant therapy, bisphosphonates, uncontrolled diabetes, latex allergy, and recent cardiac events.
Record retention and release
Retain records for the period set by state law and release copies only with the patient's written authorization; the physical record belongs to the practice, the information belongs to the patient.
Scope of Practice
What a dental assistant may legally do is defined by the state dental practice act, not by the employer's preference or by a national credential. Duties are usually divided into levels by how much training and supervision each requires.
State law governs
Allowed duties, required credentials, and supervision levels vary by state, so always verify the current dental practice act and board rules for the state where you work.
Levels of supervision
Direct supervision means the dentist is in the office and authorizes and checks the work, indirect or general supervision means the dentist authorized the procedure but need not remain present, and the definitions vary by state.
Commonly reserved to the dentist
Diagnosis, treatment planning, prescribing, surgical procedures, and irreversible procedures are almost universally reserved to the licensed dentist.
Expanded functions
Duties such as coronal polishing, sealant placement, and taking radiographs typically require specific training, a state permit or certificate, or both.
Refusing an illegal delegation
An assistant who performs a duty outside the legal scope is personally liable, and being instructed by the dentist is not a defense.
Standard of care
Negligence is failing to act as a reasonably careful person with similar training would act in the same situation, and abandonment is discontinuing care without proper notice.
Medical Emergencies and Hazard Communication
Emergencies in a dental office are uncommon but time-critical, so preparation matters more than improvisation. Chemical safety follows a separate federal standard that requires labeling, data sheets, and training for every hazardous product in the office.
Prevention and preparation
Most emergencies are prevented by a current medical history and stress reduction; the team should hold documented emergency drills and keep everyone certified in basic life support.
Emergency kit and oxygen
Keep an emergency kit and oxygen accessible and checked regularly for expiration, and know where the automated external defibrillator is located.
Syncope
Fainting is the most common dental office emergency; place the patient supine with the legs slightly elevated, ensure an open airway, and use an ammonia inhalant if needed.
Common presentations
Recognize hypoglycemia treated with oral sugar in a conscious patient, asthma treated with the patient's own bronchodilator, angina treated with prescribed nitroglycerin, and anaphylaxis requiring epinephrine and emergency medical services.
Hazard communication and safety data sheets
Maintain a written hazard communication program, a chemical inventory, manufacturer labels, and employee training for every hazardous chemical in the office, and keep a safety data sheet for each one in the standardized sixteen-section format, readily accessible during every work shift.
OSHA 29 CFR 1910.1200Mercury and eyewash
Handle amalgam scrap under approved conditions with amalgam separators and no rinsing into the drain, and provide an eyewash station where corrosive chemicals are used.
OSHA 29 CFR 1910.151Kiểm tra kiến thức của bạn
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