The Team Concept
The following is a guide and should be adapted to the
particular circumstances in each clinic or dental practice
The purpose of the team approach is to ensure the smooth and efficient progress
of a surgical procedure and to reduce the risk of mistakes being made. Every
member of the team should know the procedure to be performed and should
know all their duties and responsibilities
Since the introduction of this concept in hospital operating theatres the standard
of care has increased and mistakes have been reduced. Similar improvements
can be expected if applied to dental procedures.
The Purpose of the Team Approach
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To care for the patient better
To ensure that everyone involved knows what their responsibilities are
To ensure the procedure runs more smoothly
To ensure that all instruments available throughout the procedure
To reduce the risk of mistakes being made
It is advantageous to rotate the duties so that all staff member are familiar with
all the duties
The Treatment Team
Team Leader This may be the dentist or an experienced member of staff
Duties
Setting up a team for each procedure and ensuring that all team members know
the procedure to be performed and what their duties and responsibilities are
Operator This is the dentist who is going to perform the procedure
Patient Carer, Prepper and Clearer-upper
The patient on arrival is likely to be anxious or fearful of the procedure that they
are about to undergo. This is likely although the patient may not show it.
From the time the patient arrives the patient carer should care for the patient
until time the patient is sedated and prepped. During the start of the sedation
the patient may seem calm but may be apprehensive and not show it. Special
attention should be given to the patient at this potentially stressful time.
The Sedation Team is responsible for the care of the patient after sedation is
started.
The patient carer should leave the mouth mask around the neck until the
patient is sedated.
(Wearing a mask before this may intimidate the patient.)
Duties before the Procedure
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Find out from the Patient’s Dentist the following information:The likely state of patient’s feelings on arrival
The likely state of patient’s escort’s feelings on arrival
The pre-operative drug regimen to be used
Be prepared to meet the patient as soon as the patient arrives
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Find out the patient’s feeling about having the procedure performed
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Be prepared to answer any questions the patient or escort may have
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Find out the patient’s escort’s feelings on arrival. Be aware that the
patient and the patient’s escort may be nervous although they may not
show it.
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Check with the Patient
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Whether they are Allergic to Penicillin
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Whether they are Asthmatic
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Whether they are Allergic to Aspirin
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Have the patient
Brush their teeth and gums with Chlorhexidine Gel.
Rinse for 1 minute with Chlorhexidine Rinse
Have the patient go to the toilet just before the procedure
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Duties during the Start of the Procedure
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Sit next to the patient while they are being sedated
Reassure them
Touch them reassuringly occasionally
Start prepping the patient as soon as they are sedated.
Let the Patient Draper know when you have finished prepping
Put your mask on as soon as the patient is sedated before prepping the
patient.
Duties during the Procedure
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Talk to the Patients Escort.
Tidy up Treatment Room
Talk to the Patients Escort.
Prepare the Aspirator Cleaning Solution after re-bagging the Prep Kit
At the End of the Procedure
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Clean the Aspiration System
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Patient Escort Carer This may be several members of staff. Sometimes the
patient escort is nervous about the wellbeing of the patient. Reassuring the
patient escort is helpful. The patient carer is not gowned and gloved
Chairside Assistant This should be a member of staff experienced in
chairside assisting. The chairside assistant is gowned and gloved
Duties
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Aspirating
Retracting
Suture Cutting
Ensuring the smooth progress of the procedure
Observing the degree of comfort of the patient
Surgical Assistant
The surgical assistant is gowned and gloved
Duties before the Procedure
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To develop an understanding of the procedure to be performed on
the patient.
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To check the Diagnostic Quality of the Radiographs
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To become familiar with the Treatment Room Set –up
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To gather together all the Instruments and Equipment for the case.
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To have a bowl of sterile saline or local anaesthetic ready to wet a
gauze square. The wet gauze is used to wipe instruments clean
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To ensure that all items necessary for the procedures are available
Collect the necessary items for the procedure in a green tray.
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To have the Roving Assistant check the items against the set-up list
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Laying out of the items in the Treatment Room 10 Have the
Roving Assistant check the Layout
Duties before the Procedure when Gowned
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laying out the Mayo Table with the assistance of the Roving
Assistant
Duties during the Procedure
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To pass the Surgical Instruments and Supplies to the Operator.
To ask the Roving Assistant for any extra items that may be
required
To retract occasionally
To cut sutures occasionally
At the End of the Procedure
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Removing all the Dirty Items in the treatment room to the
Sterilizing Room Dirty Area using a Large Plastic Container
Roving Assistant The purpose of the Roving Assistant is help the
operator, chairside assistant and surgical assistant in any way that is needed.
The Roving assistant is not gowned.
Duties before the Procedure
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Know the procedure to be performed on the patient.
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Help the Surgical Assistant gather together all the Items
required for the Procedure
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Check the Items collected by the Surgical Assistant against the
Surgical Assistant List
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To be observant of any infringements of the Sterile Chain so as to
ensure the maximum level of asepsis.
Duties at the Beginning of the Procedure.
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Open the Surgical Assistant’s Gown Pack
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Assist the Surgical Assistant to Gown (Tie the Gown up)
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Open the Mayo Table Pack
(The Surgical Assistant fits the Mayo Table Cover on the Mayo Table)
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Open and Pass bagged items to the Surgical Assistant who is
setting up the Mayo Table.
Throw all Empty Opened Bags on the Floor
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Pass a Local Anaesthetic Needle.
Pass Local Anaesthetic Carpules.
Help connect the Sterile Aspirator Tubing.
Help connect the Implant Motor.
Help connect the Saline Tubing.
During the Procedure
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Pick up all Debris from the Floor during and after the Procedure
Be prepared to pass any extra items as required.
Be observant of any infringements of the Sterile Chain.
Clean up at the End of Surgeries
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Remove all Items to the Instrument Cleaning Area
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Disconnect the Saline Tubing from the connection at the Implant
Motor
Disconnect the Motor
Tidy the Work Surfaces in the Treatment Room
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Sedationist
Duties before the Procedure
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To find out the procedure to be performed
To check with the patient’s dentist the state of nervousness of the
patient
Draw up the necessary drugs before the surgery is due to start
Check the emergency drugs
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Check the emergency oxygen
Duties on meeting the patient
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Check the patient has been to the toilet
Check the time and extent of the last meal
Check the patient’s medical history
Have the patient sign a Sedation Consent form
Duties at the Beginning of the Procedure.
During the Procedure
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To keep a record of the drugs administered
The blood pressure at intervals
The Oxygen Levels at intervals
The Pulse Rate at intervals
To record timing and amount of the local anaesthetic administered
The End of Surgeries
To care for the patient’s welfare at the end of the sedation until the
patient is fit to leave
2 Using the Fitness to Leave Assessment check the patients recovery
form the sedation
3 To review postoperative instructions with the patient’s escort
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