1. ME Wener, CDHM AGM, Sept 08 1 THE EXTENDED PRACTICE RDH COLLEGE OF DENTAL HYGIENISTS OF MANITOBA Mickey Emmons Wener RDH, MEd, CDHM-TC Chair AGM Sept 27, 2008 CDHA web photo

2. 2 ME Wener, CDHM AGM, Sept 08 Today The Dental Hygiene Process of Care RDH services and supervision Requirements of the Extended Practice RDH Extended Practice in: Private practice Clients homes Personal care homes (PCH) & hospitals Oral health programs Other settings Next steps… Policies to be developed by the new CDHM Council

3. 3 ME Wener, CDHM AGM, Sept 08 RDHs are: Regulated primary oral health care professionals who specialize in services related to clinical therapy, oral health education and health promotion.

4. 4 ME Wener, CDHM AGM, Sept 08 Dental Hygiene Process of Care CDHM Practice Standards & 183 Competencies! A ssessment – 67 competencies Gather objective and subjective data Analyze data to develop a DH diagnosis within the RDHs scope of practice P lanning – 24 competencies Develop a DH care plan with the client I mplementation – 72 competencies Provide care within the RDHs scope of practice E valuation – 20 competencies Evaluate effectiveness of care COLLABORATION with other health professionals is of the utmost importance !

5. 5 ME Wener, CDHM AGM, Sept 08 Low risk of harm services: No supervision requirements for any RDH Oral chemotherapeutic agents Anticariogenic, desensitizing, periodontal chemotherapeutic agents Others as approved by the CDHM Council Sealants Applying dental sealants where after an assessment of the tooth, the dental hygienist determines that there is no obvious sign of decay Other examples: Assessment, planning & evaluation Oral health promotion and education Impressions, study models & mouthguards (NOT nightguards) Examples of their application Custom mouthguard clinics for sports teams Prevention for high risk children Oral cancer screening clinic – intra/extra oral exam

6. 6 ME Wener, CDHM AGM, Sept 08 Always provided with a dentist Restorative procedures Placement of amalgams, composites Orthodontic procedures www.prevention.com www.ada.org

7. 7 ME Wener, CDHM AGM, Sept 08 The Extended Practice RDH Promotes: Access to care in a variety of settings Autonomy Collaboration OPPORTUNITY!

8. 8 ME Wener, CDHM AGM, Sept 08 The Extended Practice RDH An experienced RDH 3000 career hours of practice Applies to higher risk procedures Scaling, root planing, debridement, local anesthesia Higher risk procedures have setting requirements Dentists office or a setting approved by the patients dentist Designated long-term care, hospital and psychiatric facilities An oral health program established or operated by: the government of Manitoba or Canada a municipality a regional health authority the University of Manitoba Facilities or programs approved by the Minister of Health

9. 9 ME Wener, CDHM AGM, Sept 08 Collaboration & Consultation for Client Safety After reviewing the patients health record the RDH-EP determines that: a) A patient does not have any MEDICAL or ORAL HEALTH CONDITION that may significantly affect the appropriateness, efficacy or safety of the procedure. If there is a medical or oral condition that may affect the appropriateness or safety of a procedure, the dental hygienist must only perform the procedure after consulting with a dentist or physician, Registered Nurse Extended Practice or Certified (Medical) Assistant, as appropriate. b) A patient is not on a DRUG or COMBINATION OF DRUGS that the dental hygienist is unfamiliar with or which could affect the appropriateness, efficacy or safety of the procedure. If the patient is on a drug or combination of drugs that may affect the appropriateness, efficacy or safety of the procedure, the dental hygienist must only perform the procedure after consulting with a dentist, physician, or pharmacist as appropriate.

10. 10 ME Wener, CDHM AGM, Sept 08 What does No Supervision for RDH-EP mean? RDH can SELF-INITIATE care RDH can do initial assessment, formulate DH diagnosis and proceed with care. Client may be seen with or without: having been previously seen by the dentist the dentist on site at the time of the appointment seeing the dentist at any time after the appointment

11. 11 ME Wener, CDHM AGM, Sept 08 How does this work in private practice? OPTIONS: In dental office, without dentist present RDH & dentist select existing clients appropriate to be seen for recall when dentist is not present - 1 hour, day, week… RDH sees new client for assessment, DH diagnosis & plan of care (med history/drugs clear), proceeds with tx RDH could be on contract (self-employed) with a dentist as an associate, whereby billings could be completed through the dentist or the dental hygienist

12. 12 ME Wener, CDHM AGM, Sept 08 Can I provide care in someones home? The client/patient is an existing patient of a dentist Of a practice you are employed in Of several practices you have established an affiliation with Patients are referred back to the dentist for any further needs, or to another provider of the dentists and patients choosing The client/patient is accessed via a governmental agency RDH establishes working relationship with an entity such as Manitoba's home care program, or any government agency providing care in the home Work with CDHM to establish groundwork to ensure success for yourself and others The RDH cannot: Start a home care business that is solely being operated by the RDH with no affiliation with a dentist or an approved/government agency Directly advertise to the public that you can be contracted independently for this service

13. 13 ME Wener, CDHM AGM, Sept 08 What about working in LTC or a hospital? RDH services particularly suited to a PCH or hospital setting: initial oral assessment (assessment/referral, oral cancer screening) periodontal therapy (cleaning and debridement) individualized daily oral care plans including product selection on-unit assistance health promotion such as caregiver in-services, family education, and oral care policy consultation Requires consent/working relationship with: the facility the unit/ward the individual/family/guardian OPPORTUNITY: RDH for Central Regional Health Authority, McGregor & District Health Centre to do initial oral assessments on admission of residents

14. 14 ME Wener, CDHM AGM, Sept 08 Referring in LTC For oral health issues beyond dental hygiene care, the dental hygienist must alert: the resident or their guardian/legally accepted representative (LAR) the staff/facility And, advocate for/refer the resident to: the family's preferred dentist a dentist working with the facility (i.e. CCOH's mobile van services) a dentist near the facility, or another suitable arrangement

15. 15 ME Wener, CDHM AGM, Sept 08 Could I work in a community-based health clinic without a dentist? Yes, if: the clinic is in one of the approved settings or programs approval is sought & granted from the Minister of Health What might I do? Work within existing programs with other health professionals Establish a new oral health promotion program Provide on-site clinical care Do home visits for infants/toddlers or older adults Refer those who need dental care beyond RDH scope

16. 16 ME Wener, CDHM AGM, Sept 08 Dental Hygienist Act Increases Access to Care in PCHs and Hospitals (news item on CDHM web site) Communiqué from the College of Dental Hygienists of Manitoba Dental Hygienist Act Increases Access to Care in PCHs and Hospitals Registered Dental Hygienists (RDHs) are regulated health care professionals who specialize in services related to oral health care, education and promotion. Preventive oral care is taking on an increasingly important role as serious health issues such as aspiration pneumonia, diabetes and cardiovascular disease have been associated with poor oral health and inadequate daily mouth care. Dental hygienists are in a unique position to help address these health issues in personal care homes and hospitals. Within a PCH or hospital setting, the new Extended Practice RDH is able to provide services as a collaborative primary health care provider working without a dentists supervision. RDH services particularly suited to a PCH or hospital setting include: initial oral assessment (assessment/referral, oral cancer screening), periodontal therapy (cleaning and debridement), individualized daily oral care plans for residents/patients including product selection, on-unit assistance, and health promotion programming and delivery such as caregiver in-services, family education, and oral care policy consultation. In accordance with the CDHMs practice standards and competencies, the Extended Practice dental hygienist completes a review of the medical/dental history, an intra/extra oral assessment and the dental hygiene care plan, prior to proceeding with clinical care. Where there exists a potential contraindication to treatment, the dental hygienist is required to consult with the appropriate health care professional. For residents/patients with oral health issues requiring attention that are beyond the scope of the RDH, the dental hygienist would alert the resident or their guardian, the staff/facility and then advocate for dental treatment. Research increasingly shows that oral health is an indicator of overall health and this legislation means increased access to oral health care for more people. Theresa Oswald, Minister of Health, News Release-excerpt, April 2008

17. 17 ME Wener, CDHM AGM, Sept 08 Other Settings: Government Manitoba - Regional Health Authorities Canada - First Nations and Inuit Health Branch Municipality An RDH-EP could become affiliated with or initiate a clinic/oral health program in conjunction with a municipality, i.e. City of _________ University of Manitoba Students can be supervised by an RDH-EP in any U of M program/clinic

18. 18 ME Wener, CDHM AGM, Sept 08 How does a non-approved setting get approval from the Minister of Health? Consult with CDHM Does setting require approval? Has it been previously requested? Submit letter to Minister of Health & CDHM Describe setting Explain dental hygienes role Provide rationale for how providing care within this setting will contribute to the publics oral health Example to date Siloam Mission

19. 19 ME Wener, CDHM AGM, Sept 08 Getting ready to transition… Preparation and support CDHA courses Self-initiation for Dental Hygienists Certificate Program: Independent Practice for Dental Hygienists DECOD University of Washington self-study (Dental Education in the Care of Persons with Disabilities) program http://www.dental.washington.edu/disability/ U of M – DH supervised clinical externships, portable equipment MB study group for those interested? Reimbursement Salaried position Fee-for-service Traditional payment RDH direct billing to plans; see CDHA web site; Must reside in a jurisdiction where it is legal Must use CDHA National List of Service Codes© for RDHs Plan must be approved for RDH billing CDHM & MDHA co-investigating

20. 20 ME Wener, CDHM AGM, Sept 08 Please share your questions & comments with us! Keep abreast by regularly checking the CDHM web site www.cdhm.info Proceed slowly, do your homework, investigate, work with the CDHM EXPLORE POSSIBILITIES!!!