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Patient Management: Sevens Steps for Success

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 My goal for this spring semester has been to concentrate my appoinntments on patient comfort.  I have set strcit guidelines and steps that I would like to master for each and every appointment.  It has been a very rewarding process and one that I will implement into my daily appointments, further beyond this semester.  Following is a list of steps that I would try to accomplish during each appointment.  Following each step, I have provided how I accomplished these, as well as successes and failures. 

1. When greeting patient, offer to carry coat, purse, or other items back to operatory and place them off the floor.

Prior to each appointment, I would stop at my locker and read a note that was placed on the inside door, in order to put myself in the appropriate mindset before getting my patient.  This note was very important to read on days that I was rushed or stressed to get to the next appointment.  At times, I didn't feel it was necessary to make that extra stop at my locker, but I continued to force myself to stop because I understood the importance of reframing my mind.

 

2. After seating patient, do a head to toe check for patient’s comfort, including checking headrest position and offering a pillow for neck/back support.

For all fifteen appointments, I would check out a neck pillow, even before I knew if the patient wanted it or not.  I wanted to be prepared, not waste time by going back to dispensing, but also serve as a reminder, by having the pillow on the counter, to ask the patient if they prefer the pillow or not. Also, I would make sure the instrument tray did not interfere with the patient's feet upon seating him/her.  Checking the headrest became the most important step for me because prior to this time period, I would not confirm the headrest was in the proper position.  More times than not, the headrest needed significant adjustments, a fact that I missed quite often before.

 

3. Offer patient Vaseline or other lip moisturizer at the start of the appointment and then a second time after two hours in appointments lasting two hours or more.  

While setting up my cubicle, I would consistently place Vaseline in a yellow container, and topical anesthetic in a red container.  I would do this because once each were out of their original containers and on Q-tips, it was nearly impossible to tell the difference.  After repetition of using the same colors, I was able to gain a routine.  Having the Vaseline at my cubicle prior to even getting the patient cued me to offer this to me patient.  However, I found it difficult to remember to offer the patient Vaseline after two hours into the appointment, but when offered after two hours, I noticed that most patients refused it anyway.

 

4. Negotiate with the patient a sign to communicate if any discomfort is occurring.  The sign will be to raise the left hand.

Raising the left hand during any times of discomfort was an ideal non-verbal communication. This is because they would not accidentally hit my right hand, and I would also be able to visualize their action better.  I had a few patients that didn't do as well with this step, and it baffles me, but I suppose it is because it is an unusual human behavior to raise a hand, rather than just trying to say something.

 

5. Ask on average at least once every 30 minutes throughout the appointment about patient comfort, including, where applicable, after injections, rubber dam placement, use of the high speed and slow speed for the first time, taking impressions.

This was the most challenging step.  I realized that thirty minutes goes by very quickly and asking constantly was hard to remember when I was focused on the procedure at hand.  After a different step in the procedure, it was easy to remember because the change of pace offered a cue for me to ask about comfort issues.  However, if the same procedure was done (for example, using the high speed) for a consecutive thirty minutes or longer, it felt monotonous to ask the patient about comfort.  Sometimes, if asking too often, it will put questions in the patient's mind that they should be experiencing discomfort.

 

6. For appointments lasting more than two hours, offer a bathroom or stretch break once mid-way in the appointment.

At about two hours into the appointments, I, myself, needed a mental and physical break too! This step was easy to implement.  I found that most patients took me up on the offer of a restroom break, which was surprising to me.  Before, I rarely took patients to the restroom, but simply asking, they were more willing to say they did indeed need a break.

 

7. At the end of appointments, offer patients some mouth wash to refresh their breath before being dismissed, assisting with suction as needed. 

I absolutely loved implementing this step into my appointment routines.  I found a lot of patients really enjoyed having the opportunity to swish with mouthwash prior to leaving.  Actually, I called a few patients in the evening and they thanked me for this and said that no one has ever offered mouth rinse before! I will definitely continue to implement this step from now on in the future.