We are excited to be sharing with you the third part of a blog series being written by our valued partner and user Dr. Randy LaFrom. Dr. LaFrom was a dentist for over 30 years before he decided to become a consultant. He has incredible insight into the dental industry and has agreed to share it. He has written a series of recommendations on what dentists should do to address the situation COVID-19 has put practices in. If you haven't read Part 1 and Part 2 yet we recommend you do before going forward! We hope you find this information helpful and are able to stay successful during this hard time.
Preparing for the Grand Re-Opening of Your Practice Part 3: Implementing Social Distancing Guidelines
We will be reviewing how you can update your back office and front office with proactive changes to keep your staff and patients safe from COVID-19 contamination by using social distancing within your practice. We will cover updating your operatory safety, creating new routines, how to maximize your appointments, and communicate with your patients effectively.
You, as the leader, along with your team, need to be as optimistic as possible when strategizing. Discuss how you can implement the mandatory distancing guidelines in your office going forward that can work longterm.
Having a Safety Officer
This will require having one team member be the Safety Officer / Infection Prevention Coordinator and take the lead on implementing and enforcing the safety precautions consistent with OSHA, and CDC guidelines. Their role is to make sure the office is successfully implementing and managing and holding people accountable. Maintaining a safe working environment while freeing up the doctor's time to providing direct care for the patients.
The Safety Officer would help train on proper disinfection protocol for surfaces, equipment and reusable devices. Make sure rooms are fully stocked and prepared for specific procedures so staff don’t have to leave the room multiple times to go get items needed to complete a procedure. Implement a procedure for opening drawers or cupboards or cabinets to minimize cross-contamination.
This could be a team member that you'll need to hire when you consider the amount of responsibility they will have. When you re-open you will be needing to catch-up to hit your annual goal and require all you staff to be focused only on patient care. Now, during your down time could be a good opportunity to start looking and doing phone interviews.
Clinical Sanitation Training
Have standardized training with your staff covering basic proper hand washing, instrument sterilization, handpiece maintenance, controlling aerosol during ultrasonic use or drilling. Cover minimizing touching faces, eyes, shaking hands, discuss tearing down and disinfecting rooms in between patients, and using additional surface protective barriers. Gone are the days of the assistant wandering up to the front desk holding a chart in their gloved hand wearing a mask.
Turning around a room may include flushing / purging the air and waterlines for a minimum of 20 to 30 seconds after each patient as well as first thing in the morning. Leaving protective barriers on the surfaces for 10+ minutes after a procedure to let the aerosol that was generated have a chance to settle and dissipate before uncovering them could be an additional precaution.
This may lead to needing extra treatment rooms to allow additional time in between patients for properly disinfecting a room or change how you schedule patients. It may include adding an appropriate type of high efficiency particulate air filtration system along with Ultraviolet Treatment of ventilation system in the operatories.
Consider taking more digital impression scans to minimize storing models, risking contamination and making it easy to share with labs and compare to previous years impressions to see changes in the wear of the teeth, rotations or tilting of teeth for orthodontic reasons. They also work great with "gaggers" who can’t tolerate an impression tray in their mouth, or people who have braces or bridges or implants, or severe crowding or undercuts.
Use scripting to answer common questions
Patients will now be paying closer attention to what you and your team are saying and are doing while serving them. How will you prepare?
Hold a team meeting and give the team consistent scripts to say, that are simple and easy to remember. The goal is to have a united approach when you communicate with your patients what they need to know to give them the confidence to come back in to have work done. Train your staff to avoid going into too much detail, because it may not be necessary and it might bring up additional concerns. This could require your team to memorize more information then needed.
Encourage doing more quadrant dentistry and completing more procedures in one visit to minimize exposure and limit excessive PPE usage and costs involved in turning around a treatment room. Optimizing your schedule will help.
You can also try to schedule households at the same time to help control exposure. Consider reaching out to patients who still have insurance funds available to complete a treatment plan or get a hygiene appointment done. Some patients might be losing their jobs but still have access to their company insurance until the end of the year.
Most likely you'll need to adjust your schedule to compensate for longer operatory turn around times. Make sure you time your new process so you can properly update your appointment book and provider hours.
The Square Practice Platform is a powerful, risk-free tool for maximizing your schedule by showing you your best opportunities via their patient information powered Chart Check, your available provider hours via the Admin tool and your daily opportunities via the Daily Huddle. Contact us to learn about our Squared Away Guarantee.
Update You Waiting Room
You want to give an immediate perception of a sanitary office immediately upon walking into the office. Spreading out or removing some of the chairs in your waiting room lobby. Make the area look as clean and uncluttered as possible. Remove things like magazines, toys, and provide hand sanitizer instead. Add instructions to wipe or use sanitizer when using the water cooler. Rethink any coffee or snack center you may have in your reception area. Consider communicating what you are doing to help protect your patients by posting the steps you are taking on the wall. Lastly, consider having free WiFi available as an alternative form of entertainment while waiting.
Set up your patients for success
- Using non-contact digital thermometers to screen them before bringing them back for treatment. Limit visitors into the office and especially the operatories. Have facemasks or cloth coverings available to patients or family in the waiting reception area.
- Making sure every patient is wearing protective eyewear during procedures. Using larger size disposable bibs to cover their clothing more when there will be aerosol created from drilling, air abrasion, air polishing, or using an ultrasonic scaler.
- Consider having the patients do a preprocedural swish with an Antiseptic Mouthwash such as Chlorhexidine or 1.5% Hydrogen Peroxide for 10-30 seconds prior to doing surgery, restorative work or cleanings. This will help reduce the bacterial count in the mouth and saliva.
- Do more hand scaling instead of using the ultrasonic cleaner to minimize aerosol. Potentially using a rubber dams for most all restorative procedures that would involve saliva or spraying. Using HVE within one inch of drilling for all procedures that create aerosol or plume such as a Class IV surgical type laser or electrosurgery unit.
Current Conversations in Dentistry Include:
- The additional challenges come when wearing magnification loupes under face shields or around certain masks.
- The N-95 masks are expensive and new ways to disinfect them and reuse them are being investigated.
- The possible use of Negative Pressure Isolation in the Provision of Dental Care. Creating special Airborne Infection Isolation Rooms for surgeries with special filters.
- The financial impact of implementing these additional guidelines to small businesses.
- The proper usage of specific types of gloves and masks in various activities (direct patient care vs. housekeeping duties- sterilizing instruments and disinfecting rooms) in the dental office including how to properly put them on and take them off, and in the correct order.
- Scheduling consultations and exams in the morning and aerosol-producing type procedures at the end of the day to minimize airborne contamination.
- Procedures to minimize cross-contamination with administrative staff including door knobs, chairs, phones, computers, pens, counters, restrooms, etc.
- Health and Safety Practice Survey of Healthcare Workers by the CDC -The National Institute for Occupational Safety and Health (NIOSH)
- Laser Safety in Dentistry: A Position Paper by the Academy of Laser Dentistry
- Aerosols and Splatter in Dentistry – A brief review of the literature and infection control implication JADA, Vol. 135, April 2014
- Transmission Precautions for Dental Aerosols – published in The Journal of Multidisciplinary Care Decisions in Dentistry. December 2018 edition
- Disinfecting N-95 masks withDry Heat Ovens
- Negative Pressure Isolation in the Provision of Dental Care
- Role of the Infection Prevention Coordinator
- Proper Glove Use Prevents Spread of Infectious Diseases
- Disinfection of Clinical Surfaces and Equipment
- iTero Element 5D Digital Impression Scanner
- CDC Interim Infection Prevention and Control Recommendations
More on this topic will be included in Part 4 including more specific actions you should be doing right now to ensure your success and survival in 2020.
In the meantime, we wish you and your families well. We offer complimentary online presence evaluation, marketing advice, and team building coaching to help you grow your practice. Give us a call or email us for more information.
Dr. Randy LaFrom
Business Consulting and Practice Strategies.