A retrospective service evaluation of safeguarding activity in a dental

general anaesthesia service.

Elizabeth O’SullivanJulie Kelly

City Health Care Partnership Hull

BackgroundDental General Anaesthetics (DGA) were moved into

hospitals only in 2001Prior to this 15% of all UK DGA’s were carried out in

Hull in General Dental PracticeGuidelines for the management of children referred for

DGA published in 2011Recommended that assessments and treatment planning

was carried out by a specialist in Paediatric DentistryCHCP Hull took over this service as a specialist led

service in 2012DGA carried out in hospital by same provider as

previously

Population StatisticsHull 2011 Census East Riding 2011

CensusPopulation 256,500Children (0-16) 62,00024% of populationEthnic Minority 12.4%Childhood Poverty 32.9%

Population 334,000Children (0-16) 72,00021% of populationEthnic Minority 4.9%Childhood Poverty 13%

Multi-Disciplinary teamReferring Dentist – GDP,

SDS - proformaSpecialist Led Assessment

Service – working in a community setting with close links to Health Visiting, School Nurses and Safeguarding practitioners

General Practitioner Led GA Extraction List in Acute Hospital on Saturday am

ObjectivesTo evaluate the

safeguarding activity in a new Dental General Anaesthetic Referral Service

To use a multi-disciplinary team approach to address issues for those families who fail to engage with dental services.

Vulnerable PatientsChildren with high decay

experience, from socially disadvantaged families represent a high need group.These children are more likely to have safeguarding issues or come from minority groups requiring an interpreter for appointments.

Service evaluationContinuous service evaluation carried out as

know vulnerable group of patients:

Failure to attend appointmentsIssues with consentInterpreting Services

Safeguarding referrals

First AppointmentInstructions regarding venue and time of

appointmentWhat they need to bring with themWho needs to attendPaperwork around consentEvaluation of interpreting needs

Failure to attend AppointmentsFailure to attend 1st assessment appointment:2012 – 21%2013 - 17%2014 – 17%Carers get a telephoned appointment

together with written/posted instructionsText or telephone confirmation of

appointment the day before

Failure to attend appointmentsIf failed appointment: letter sent advising of failed

appointment, asking them to phone in to make another and information regarding sharing information with GP, health visitor, school nurse, safeguarding

Posters in waiting area alerting carers to fact information shared

Introduction of policy to share information with other healthcare workers/social care

Immediate information sharing with our service if fail GA appointment

ATTENTION PARENTS /CARERS.

In the interest of service improvement and the benefit of safeguarding children,

information may be shared with other Health care professionals, such as GP, Health Visitor or School Nurse.

Information SharingAssessment sheet collects not only Dental

and Medical InformationAlso

School/Nursery child attendsHealth VisitorGPSocial Care involvement

Failure to attend appointmentsAbove policies have lead to 74% of patients

that initially fail to attend being seen at a second appointment.

Patients failing to attend 2nd or 3rd appointment are followed up and are likely to get a social care referral.

ConsentIssues with consent: adults without PR

attending assessment appointments, carers not understanding who can consent

Wasted appointments/ Repeat appointments

Education of referring GDP’sTelephone information to carers when first

appointment madeSame person signing consent attending both

assessment and GA appointment

Interpreting servicesGrowing part of serviceIn 2012 only a handful of patients needed an

interpreter.Now 18%

Different health beliefs around GA, extracting decayed teeth

Use of interpreters when safeguarding issues arise

ConclusionsChildren in certain parts of the country have

no access to specialist led services for dental treatment under general anaesthesia. This often leads to poor treatment planning, repeat GA’s and failure to assess safeguarding issues adequately.

By highlighting best practice and the very real safeguarding issues associated with this group of children we can help other services in the commissioning process of specialist services