Sadly the dental surgery environment is not always conducive to effective communication. Often the dentist and other members of the dental team are dealing with a variety of patients, all with different needs, and they may be subject to severe time pressures.

Meanwhile, patients can be distracted; they may be in pain and slightly nervous, or may be feeling vulnerable and unsettled by an unfamiliar treatment provided in an unfamiliar environment. They may even be overwhelmed by the relief of finding a sympathetic dental team.

To overcome these difficulties practitioners need to choose words and phrases that the patient can understand and relate to. In addition it helps to find the right moment and an empathetic manner in which to deliver them. Even then, a nervous or distracted patient may still not hear or understand the whole message that is being conveyed.

Post-operative instruction (POI) sheets are a useful adjunct to the communication process, and serve to reinforce the information that is given verbally. Once out of the surgery environment, a patient is usually much better placed to concentrate and act upon the post-operative advice which can take many forms, depending upon the treatment provided.

Post-operative instructions

Face-to-face communications with the patient allow the clinician to fine-tune the verbal delivery of information to suit individual needs. To cater for patients whose first (or only) language is not the same as that normally used in the practice, it may be necessary to have the POI sheet produced in more than one language. Illustrations can be helpful, but one needs to be mindful of the fact that a diagram that is easily understood by the clinical team, may have little or no meaning for a lay person.

Record keeping

It is important to record the provision of post-operative instructions and advice in the clinical notes. Wherever possible, the specific advice given in a specific situation to a specific patient should be recorded in detail. However, where standard advice is concerned, and a written POI sheet is given, record keeping is made easier if each POI sheet is given a reference code, so that an entry such as ‘POI/6 given to patient’ serves to confirm the details of the information provided.

Team approach

Dental nurses and reception staff play an important role not only by ensuring that the correct POI is given, but also that this fact is recorded in the patient’s notes. Dentists, hygienists and therapists should be alert to those occasions when the advice given to a particular patient differs in some way from the standard advice normally given. On these occasions, a record should contain a summary of the actual advice given, and any aspect of this advice which may have been given added emphasis when talking to the patient.

Action plan

1. Review any POI sheets that are in use in the practice. Consider their content and decide whether any different/additional information could be helpful.
2. Consider whether it would be useful to create additional POI sheets to be used in connection with other dental procedures.
3. Consider whether the diversity of your patient-base makes it desirable to produce POI sheets in more than one language.
4. In discussion with other members of the dental team, agree responsibilities for providing this advice, recording its provision and auditing the process to ensure that it is consistently effective.
5. Over an appropriate period of time, extend your use of POI sheets to fill any perceived gaps, according to the range of procedures you undertake.
6. On a periodic basis, carry out a random audit of record cards (or computerised records) to ensure that the agreed approach to the provision of postoperative advice and instruction is being maintained.

Summary

The provision of postoperative advice and instructions is part of the duty of care that is owed to any patient. Failure to give such information can lead to complaints and allegations of negligence. Fortunately this is one aspect of dental care where an effective risk management solution is remarkably simple to achieve.

Prevention

• Warning patients (or the parents of a young child) to take particular care not to bite the lip or tongue following an inferior dental nerve block injection.
• Warning patients not to bite heavily upon a recently placed amalgam restoration.
• Warning patients not to blow their nose after an upper molar extraction where an oro-antral fistula is suspected.
• Warning a patient not to drive or operate any machinery or electrical appliance following the administration of sedation.

Home care

• The management of an extraction site.
• The care of an orthodontic appliance.
• Home care protocols following the provision of immediate replacement full dentures.
• Warning of the need for a responsible adult to supervise a patient on discharge from the surgery following any kind of sedation, not only during the journey home but also in the subsequent period until the patient is fully recovered.

Explanatory warnings

• Potential sensitivity following a deep filling possible swelling or bruising following a surgical removal of a third molar tooth.
• Possible sensitivity and discomfort following a deep scaling and root planing procedure possible tenderness on biting, following endodontic treatment.

Other information

• How to contact the practice within or outside normal surgery hours, if there are any post-operative problems.
• What happens next (for example, the interval at which a further review appointment is advised).

Consistency

Written POI sheets have the advantage that they are consistent. There is no risk of important information being overlooked through lack of time or for other reasons. A possible disadvantage, however, is that the information (and the words used) cannot be tailored to the needs of an individual patient. POI sheets should never be used in isolation. As a complement to your own verbal instructions they can be extremely useful, but they should never be used as a substitute for those careful verbal explanations.