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Medicolegal consideration
This document discusses guidelines for preparing a dental office for medical emergencies. It outlines steps for basic life support (BLS), including positioning, airway, breathing, circulation, and definitive treatment. All staff should be trained in BLS and emergency drills should be practiced. The office should have an emergency kit stocked with critical drugs and equipment. Proper documentation and informed consent are important for medicolegal considerations to avoid malpractice claims.
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Medicolegal consideration
- 1. CPR Course Preparation Medicolegal ConsiderationLec.# 2 Mar.11,2009 Dr. Adel I. Abdelhady (BDS, Msc, (Tanta,EG.), Phd (EG.USA .Oral and maxillofacial surgery dept College of dentistry, King Faisal university, KSA
- 2. Introduction Despite every effortto prevent them, life threatening emergencies do occur in dental offices. Prevention, is not always enough. The entire dental office must be prepared fully to assist in the recognition and management of any potential emergency situation.
- 3. Guideline Guideline have beenestablishes to help doctors and staff members adequately prepare for the rapid and effective management of life-threatening situation The guideline provide lists of required personnel, equipment, and emergency drugs for the safe and effective management of emergency situation.
- 4. .P.A.B.C.D The doctors shouldbe always expected to initiate emergency management and be capable of sustaining patient’s life through application of steps of basic life support BLS: P positioning A airway B breathing C circulation D definitive treatment
- 5. The office staffmembers must be prepared to manage problems and emergencies that may arise in the doctor’s absence . 1-Staff training should include BLS instruction for all members 2-Office preparation should include the posting of emergency assistance numbers and the stocking of emergency drugs and equipment.
- 6. Training Training of officepersonnel for BLS Ability of the all office staff personnel to administer BLS and CPR according to AHA Its preferable that some personnel prepared for Advanced Cardiac Life Support (ACLS ) BLS Drill should be maintained for all personnel
- 7. Team Management Duties ofteam member 1 1-Provide BLS as indicated 2-Stay with the victim 3-Alert office staff member Team member 2 should gather the emergency kit and portable oxygenO2 system and bring them to the emergency site
- 8. Teamwork Duties of teammember 2 1-Bring emergency kit and O2 to the emergency site 2-Chick O2 daily 3-Ckick emergency kit weekly
- 9. Teamwork Team member 3acts as a circulating nurse or assistant. Duties of Team member 3: 1-Assist with BLS 2-Monitor vital signs 3-Prepare emergency drugs for administration 4-Activate EMS system 5-Assist as needed 6-Maintain record 7-Meet Rescue team at entrance
- 10. Emergency Practice Drill Lifethreatening conditions occurs infrequently , the team becomes rusty because they are not given enough opportunities to practice. Annual refresher courses Periodic in-office drills help to maintain efficient emergency teams in the absence of true emergency situation All members of team should respond exactly as they must under true emergency condition
- 11. Office Preparation: Emergency medicalassistance Whom to call ????? The team member who calls EMS operator must to remain calm and clearly provide the operator with all requested information. Call 997 for ambulance service and nearby hospital
- 12. Emergency Drugs and Equipment Itemsin an Emergency Drug Kits 1-Moduule one: Basic emergency kit critical drugs and equipment 2-Module two: Noncritical drugs and equipment 3-Module three: ACLS 4-Module four: Antidotal drugs
- 22. Critical Noninjectable Drugs Thefollowing non-injectable drugs are considered critical: 1-Oxygen 2-Vasodilator 3-Bronchodilator 4-Antihypoglycemic 5-Aspirin
- 23. Primary Noninjectable Vasodilator Nitroglycerin asa tablet and a spray and an inhalant in case of chest pain or a history of angina pectoris or Amyl nitrite Noninjectable Bronchodilator *Drug of choice Albuterol , ventolin *Noninjectable antihypoglycemic orange juice *Primary noninjectable antiplatelets Aspirin *Parasympathetic blocking agent anticholinergic atropine
- 24. Critical emergency equipment 1-O2delivery system 2-Syrings 3-Suction and suction tips 4-Tourniquets 5-Magil intubation forceps
- 26. Scalpel or cricothyrotomydevice Could be added to emergency kit Laryngoscope Artificial airway, endotracheal tube
- 28. ALS Airway/ VentilationMethods
- 29.
- 30.
- 33. Module three: ACLS ACLSEssential Drugs 1-Epinephrine to manage cardiac antidysrhythmic drugs 2-O2 3-Lidocaine 4-Dopamine, intropin stimulate alpha and beta receptor for treatment of hypotension in absence of hypovolemia 5-Morphine analgesic , opioid agonist Atropine drug of choice for hemodynamically significant bradycardia
- 45. Medicolegal Consideration Pertaining tolegal aspects of the practice of medicine (as malpractice or patient consent for operations or patient information) The patient in order to win the case , a jury must find the plaintiff proved the following things: 1-That the dentist was at fault 2- That the dentist’s fault was the cause of injury to the patient That the injury must be companseted in dollars ( damages)
- 46. Standard of Care Ajury must find that the dentist acted negligently before the patient can recover damage The term negligence or malpractice The judge tells the jury that negligence is : 1-doing something that an ordinarily prudent dentist would not do under the same or similar circumstances 2-not doing something that a reasonably prudent dentist would do under the same or similar circumstances
- 47. The judge’s instructsthe jury that negligence is the failure to practice ordinary care. This is the point at which the testimony of the expert witness enters the picture. The judge instruction guide the jury with regard to the indispensable expert testimony against the dentist, the judge instructs the jury that each side may call an expert witness to define the standard of care and testify how the defendant dentist met or failed to meet the standard
- 48. Procedure differs ina lawsuit in which a jury must determine whether a dentist is at fault , the expert whiteness those individuals who possess special training and experience and whom the court has acknowledged to possess the skill or education necessary to offer opinion to the jury may testify
- 49. Forseeability of theemergency A cardiac arrest or an idiosyncratic reaction to medication or anesthesia in a dental office arguably may not be foreseeable events. Experience tells us that medical emergencies were unpredictable, more service-oriented employees are learning how to administer procedures like CPR correctly.
- 50. Certain circumstances indental clinic are much more likely to precipitate a medical emergency this higher likelihood of emergency helps explain the higher expectation of care. Many people experience fear and anxiety at the mere thought of an upcoming dental appointment .By time these people actually reach the office, their fear and anxiety can cause measurable metabolic changes in addition fear , anger and frustration and waiting for long time in waiting room add to the metabolic changes.
- 51. A highly stressedpatient is not the ideal candidate to receive anesthesia and medication and may lead to increase the risk that the medical emergency may develop in anxious or nonanxious patients alike
- 52. Grounds for MalpracticeLiability Lack of Informed Consent Intentional Misconduct سوء تصرف متعمد Breach of therapeutic promise Patient injury from dangerous treatmentrelated activities (strict liability) Patient injury from defective treatment related products (strict product liability) Negligence – substandard care delivery
- 53. Standard of Care Standardof Care is articulated by the expert witness Does the record help the expert witness to evaluate conformance with the standard of care? Does the record help the expert witness to convince the jury?
- 54. Elements of Proofof Negligence The defendant had a legal duty to care for the patient The defendant breached the duty to care for the patient, i.e. did not conform to the STANDARD OF CARE The breach of duty caused injury to the patient The plaintiff suffered damages which are compensable.
- 55. Informed Consent Informed consentshould be obtained, but in essence informed consent requires that a dentist explain a patient the following information in sufficient detail so that the patient understands: 1-Reason for care and treatment 2-Diagnosis 3-Prognosis 4-Alternative
- 56. Informed Consent cont’s 5-Natureof care and treatment 6-Risks involved ( inherent risks included) 7-Expectation of success 8-Possible results if the patient does not undergo care and treatment or does not follow instructions.
- 57. Dentists are expectedto be more prepared to prevent or to treat emergencies situations. Therefore each dental office should be staffed with appropriately trained personnel who know their assigned tasks in case medical emergencies does develop
- 58. CPR cannot beadministered by effectively by only one person, so dentist who do not ensure that someone other than themselves knows CPR techniques may not be protected in court, because CPR administration is a foreseeable circumstances with which most dentists will be confronted at some time All office members should be familiar with proper CPR technique and maintain current CPR certification.
- 59. Proactive Measures Each dentistshould establish a relationship with an experienced malpractice defense lawyer in case of lawsuit arise .Dentist should be keep in touch with that lawyer and seek legal advice just as a patient seeks periodic checkups for preventive care
- 60. The Artifact Argument Computerbased record logs all data including false or artifactual data Artifactual data can indicate an untoward physiologic change Can artifact lead to proof of negligence when there was none? Unambiguously document an untoward change Linked to an undesired outcome Interpreted by an expert witness as substandard care
Editor's Notes
- #53 There are a number of grounds for bringing a malpractice suit. I would like to focus on negligence since it is the most common grounds used and probably the one where the anesthesia record is most likely to be carefully scrutinized and may have some ambiguity. A plaintiff can bring suit for malpractice on a variety of grounds but the most common is for negligence, I.e., substandard care delivery. When a provider is accused of negligence, the anesthesia record becomes the primary document for evaluating the care that was rendered.
- #54 This may be an oversimplification of the complexity of this issue but I believe the crux of the malpractice question relates to whether an automated recordkeeper a) helps a credible expert witness to determine whether or not the defendant adhered to the generally accepted standard of care and b) helps that expert witness and the defendant’s lawyer to convince the jury of that fact. Ultimately, there will be expert witnesses from both sides of the suit who will be asked to examine the record of care and render an opinion on whether or not the care provided conformed with an acceptable standard. There are several arguments that have been advanced to address these questions.
- #55 When a plaintiff brings suit for negligence, the burden of proof requires that four elements of proof be satisfied…. The evaluation of conformance with standard of care is the most fundamental aspect of proving negligence since a provide cannot be held liable even if injury did occur as long as they conformed with the standard of care.
- #61 Implicit to the concern over the exposure from these records is the assumption that the provider does nothing wrong yet the data recorded by the AIS helps the plaintiff’s case in a malpractice proceeding. In the case of artifact, … Reluctant to give up the handwritten record since it offers control over the content of the record