AWI/IHS/RA

what does in capacity actually mean

•  Acting - can pt act on basis of info, eg i can come to appt or oh no i cant come ad busy so they phone up. 

• Can pt MAKE a decision 

• COMMUNICATING a decision eg speaking, writing a reply 

• UNDERSTANDING a decision 

• RETAINING MEMORY of decision EG CONSISTENT WITH THEIR DECISION 

• AMCUR

how do we asses capacity

dht cannot asses somones capacity only doctors and dentits can take training

how can we check paitent understands capacity to consnet

open question, chunk and chwck , treahc back

avoid asking paitents to repeat what u said,this doesnt demonstrate what they understand

what is the adults within capacity act 2000

• Adults within capacity act 2000, first piece of legislation to be passed by the scottish parliament, the  act safeguards the welfare and manages the finances of people aged 16 years and over who lack capacity

what are the key priniciples of of AWI act 2000

• has to benefit paitent

• least restrictive of Freedom

• persons past and present wishes should be taken into account

• consult relative otehrs

• encourage residual capacity

what is proxy

a subsitute is used for someone who has been authorised to act on behalf of an adult with incapacity

types of proxy - powers of attornery , granted by adult whlist they have capacity to choose who they wish to act on their behalf should need arise similar to wiill , must be in writing and must be registered with OPG

types of power attorney

welfare- NHS

continuing - house money

joint or combined NHS,HOUSE,MONEY

who can complete an AWI

doctors nurses opticians

what is concious sedation

A technique in which the use of drug or a drugs produces a store a state of depression of the central nervosue system enabling treatment to be carried out

what are types of concious sedation

inhalation-mask

intra venouse vein

oral - medicine

intranasal -not wideyle avaible yet

everyone gets the same dose of oral avg 10 mg

what is conscious sedation assesment

through MH, through SH where u live , airway assesment , height weight BMI heart rate BP SPO02

standard techniques

Inhalation sedation 

• Gas, nitrous oxide and oxygen 

• Mild sedation , mild anxiety 

• Sucess in childrne and adults 

• Anxiolytic effects 

• Analgesia effects 

• Post hypnotic suggestio

what is used in sedation

nitrous oxide, inhaled gas colourless heavy and falls to floor sweet smelling

sometimes laughing gas

entonox , rapid onsent action

crossed the blood brain barrier rapidly

elmination also rapid

no signifanct metabolism by kidneys or liver

no hangover effect

ihs indicayions when would someone need this

needle phobic, not suitable for other tx , straightforward dental tx they cant manage , mild anxiety , someone who can listen to instructions

what are contraindications

COPD,pink puffers and blue bloaters

recent eye or ear surgery

mask intolerance , pregnancy , vit b12 defincey , methotrextate , chemo

what is IV Sedation

delivered as injection, mild anxiety , need to cannolate , ttusted t required to take home, follow rules for 24hrs , no driving cooking, amnesia, must have reverse drug flumazeni