DHYG 258: LO2- Develop a DH Care Plan

definitions of DH care plans

-prioritized sequence of interventions based on dx to address the needs of the client's OH

-a written blueprint or plan that the DH and client use to meet the clients OH needs

care plan vs treatment plan

-care plan rather than treatment plan better describes the broad range of preventive, educational, therapeutic and support services

describe DH care plans

-developed in planning phased

-based on assessment & diagnosis, a client-centered approach & best resources available

-includes plans to resolve problems (preventive, educational, therapeutic & supportive)

-limited DH scope of practice

-include goals & interventions

-provide info to clients (actively involved in decision making)

rationale for DH Care Plans

-individualizes client care and focuses on client priorities  (client-centered care)

-facilitates communication for working collaboratively with client and other health care professionals

-provides direction (a blueprint) for implementing interventions to meet established client-centered goals and evaluating them – determine priorities

-facilitates the monitoring of client progress (evaluating goals/outcomes & planning CNC)

-serves as a way to communicate with client-informed consent for care

when is a care plan used?

-used as a guide for each appt; it is updated at each appt

-serves as a document when evaluating outcomes (completed only when therapy is evaluated & CC needs are determined)

-provides a review of previous care (should always look back at goals & CNC needs- were goals meet and appts made?, what did we do last time? did it work? what was achieved?)

what are the components of a DH care plan?

-client info & chief or client concerns

-DH interventions

-goals

-appt schedule (how many/what at each appt)

-informed consent

-outcomes of therapy & CNC needs (were problems resolved? were risks reduced?)

what do well written care plans contain/do?

-reflect goals of the care

-consistent with the client's needs, priorities & readiness to change

-show a relationship b/w DHx-goals-interventions

-reflect current standards of care

-compatible w/ dentists care plan

-reflects current standards of evidence based care

-meets the clients psychosocial, cultural and physical needs

-identify DH responsibilities

-establishes priorities of care

in Canada, DHs are guided professionally and ethically by CDHA's

-Code of ethics

-Entry-to Pratice Competencies and Standards for Canadian Dental Hygienists

-Clients Bill of Rights

-Entry to Practice Canadian Competencies for DHs

CHDA Code of Ethics (2024) 5 principles

-beneficence (caring about and acting to promote the good of others)

-autonomy (the right to make one's own choices)

-integrity (consistency of actions, values, methods, expectations and outcomes)

-accountability (taking responsibility for one's actions and omissions)

-privacy & confidentiality (duty to not disclose any info acquired in the professional relationship.. respect a patient's privacy and hold in confidence info disclosed to them except in certain narrowly defied expectations)

what is the College of Dental Hygienists of Saskatchewan (CDHS)

-a self-regulating organization representing over 600 DHs in Sask

in Sask, what are DHs guided by?

-Dental Disciplines act (defines our scope of practice)

-FDHRC Dental Hygiene Competencies

-Practice Guidelines (position statements)

Dental Discipline's Act: DHs are authorized to

-communicate an assessment & tx plan regarding periodontal health

-perform supra & subg debridement

-perform ortho & restorative procedures consistent w/ an approved education program in DH

-administer LA

-expose, process & mount rads in accordance to Radiation Health & Safety Act

professional responsibilities in care planning summary: DHs must

-make care plans that are based on clear & accurate clinical findings

-collect informed consent (support clients ability to make informed decisions about their care)

-care must be implemented & evaluated

-CC needs including referrals

interventions for meeting client goals: steps

-step 1: review DH diagnosis & related risk factors

-step 2: determine goals that could be reached to help bring client toward improved OH

-step 3: recall knowledge from previous courses regarding DH care (assessment & fundamentals, dental records, social psych, prev dent, perio/nutr/rad)

-step 4: consider interventions that are supported by specific literature to either eliminate or control factors that contribute to the OH problems

-step 5: select preventive, therapeutic & educational interventions for each DH diagnosis

-step 6: select only interventions that are within the scope of DH practice

-step 7: list interventions in the interventions column of DH care plan

AAP Parameters of Care

-for perio diseases

CAMBRA

-for managing caries risk

ADA guidelines

-for selecting radiographs

CDHA & CDA

-position statements

what are interventions for risk for caries?

-sealants (if deep grooves)

-recommend xylitol products (for reduced saliva)

-fluoride/desens (for exposed roots)

-refer to DMD (if defective restos)

what are interventions for gingivitis?

-BFS/education (if biofilm)

-nutritional couns

-debridement (if heavy calc)

-margination/refer to DMD (for overhangs/defective restos)

what are interventions for recession

-BFS/education (if toothbrush technique)

what are interventions for smoking

-smoking cessation

what should we give time b/w appts for?

-LA

-TMJ problems

-healing time before evaluating changes to lesions (10-14 days)

-clients cannot attend AM & PM appts in each day

-healing time before evaluating changes to perio health (2 weeks gingivitis, 4-6 weeks periodontitis IF eval appt is planned)

-10-14 days b/w when antibiotics are required

-med conditions may require certain times of day

-consider clients ability to endure long appts (SRP)

time b/w appts: debridement

-a week apart but can be more often

time b/w appts: LA and TMJ

-1 week between

time b/w appts: healing lesions

-10-14 days

time b/w appts: resolution of gingivitis

-2 weeks

time b/w appts: healing for perio

-4-6 weeks for CT

scope of practice

-the broad range of duties legally defined for a particular health care provider

informed consent

-agreement to accept the plan with enough knowledge about the plan

informed refusal

-declines the care (with enough knowledge about the plan)

what is the rationale for effective presentation

-to solidify understanding of the problems, goals and solutions

-to provide enough info for the client to give "informed consent" for treatment

-to ensure mutual cooperation & understanding

-to reinforce the client's role in setting & reaching goals

what is key to ethical & legal practice

-communication of a client's assessment findings and care plan

what are our professional responsibilities

-communication of a client's assessment findings and care plan

-Client's Bill of Rights

-ethical practice (CDHA Code of Ethics 2024)

which topics are explained while presenting a care plan to a patient?

-the desired or expected outcomes/goals of care ("debridement will allow the tissue to begin to heal")

-how outcomes will be evaluated ("the results can be evaluated by measuring the bleeding after some time for healing")

-consequences of not receiving the recommended therapy (what should be the expected outcomes if the care is not provided-tooth loss?)

-alternative programs (shorter CNC if no perio referral)

when is informed consent provided?

-after presentation of the care plan and consequences of not receiving care

informed consent criteria

-explanation of diagnosis, interventions, and duration of care

-risks & limitations

-benefits of completing care

-alternative options as well as no treatment & consequences of no treatment

-demonstration that the client understands

-translator/app if needed

-legal guardian must be included if minor or individual w/ cognitive impairment

-can be informed consent or refusal

how can we help ensure informed consent?

-begin communication of assessment findings during the appt

who can give informed consent?

-a client who is 18 & legally competent

-a parent/legal guardian if client is under the age of 18 or legally incompetent

obtaining informed consent: DHs

-ask client if they accept the recommendations and schedule

-collect client's signature

-continue to inform client at all appts so that they are always aware

providing informed consent: the client

-accepts the care plan (they have the right to accept or refuse)

-has enough info to give rational choice

-will sign the care plan to make it a legal documentation

informed refusal: documentation

-describe detains in the DH Care Plan Diagnosis and/or DH Care Plan Outcomes

-fill out "Declined Procedures"

-date the entru

-ask client to sign the entry AFTER an instructor has approved

what should goals include?

-a subject, verb, criterion for measurement and time dimension

-use measurable verbs (decrease, increase, eliminate, prevent, stop, improve, make)

when is a care plan complete?

-outcomes are assessed or evaluated

-CC needs are determined

-client has been informed of the CC needs