10 • Practice


Dental adviser Rachael Bell explains the many benefits of working alongside a chaperone or chairside assistant


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LLEGATIONS of inappropriate behaviour have not been far from the headlines in recent months, so what better time to reflect upon the arrangements we make in dental practice for chaperoning?


The English word ‘chaperone’ was first


recorded in the 15th century and originally meant ‘hood for a hawk’, later referring to ‘an older woman who protects a young unmarried female.’ The dental surgery is hardly like a scene from Pride and Prejudice, with a dental nurse awkwardly listening in to what is going on whilst pretending to be invisible – or at least it shouldn’t be. The term chaperoning is commonly used


when we think about protecting patients and ourselves from accusations of ‘boundary transgressions’. But the role of chaperone – or what is commonly referred to in dentistry as a chairside assistant – encompasses a far greater range of responsibilities.


Appropriate support Aside from the practicalities of delivering care to an upper 7 unaided, and providing an extra pair of hands so we have a chance of reaching old age with our backs intact, chairside assistance provides for: a second person in medical emergencies; a witness to what is said and done; reassurance for the patient; and physical protection for both. The rise in dental litigation should have sensibly seen the end to practising dentistry unaided, and yet we take calls daily from members of the dental team querying whether they can work alone. Traditionally, hygienists and therapists have been expected to work without a designated dental nurse, and often business reasons are quoted for the lack of chairside assistance being provided. Whilst we live in the real world where staffing comes at a cost, the financial practicalities of running a business have to be balanced against the risks of working unassisted. The General Dental Council’s Standards for


the dental team states that “you must be appropriately supported when treating


THE DENTAL


patients”. Their use of the term ‘must’ means this is non-negotiable. But what do they mean by ‘appropriately supported’? One might imagine that a nurse only popping in to clear away instruments for the LDU was not the intention behind their drafting. The Standards go on to say “you should work with another appropriately trained member of the dental team at all times when treating patients in a dental setting.” The only circumstances they say this doesn’t apply are when:


• Treating patients in an out-of-hours emergency


• Providing treatment as part of a public health programme


• There are exceptional circumstances. The GDC define exceptional circumstances as


“not routine and could not have been foreseen”, pointing out that “absences due to leave or


training are not exceptional circumstances.” The use of the word ‘should’ in the GDC’s


guidance above does mean that there may be circumstances when a dentist could treat a patient unassisted. Any practitioner would be expected to be able to demonstrate that they considered the particular patient, procedure and their own skills and experience before making the decision to work alone. That said, the GDC specifically indicate that they use the word ‘should’ when explaining how you will meet the overriding duty which is that you must be appropriately supported. One of the overarching principles of the


Standards is that dentists should “put patients’ interests before your own or those of any colleague, business or organisation”. Using financial circumstances to justify the non- provision of chairside assistance could put the practitioner in breach of this.


Patient safety Patient safety is paramount to the GDC who


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