5.7.1 - Emergency Management

There is always the possibility, however slight, that a medical emergency may arise. The following constitutes a standard protocol for the initial management of all medical emergencies:

1. Position the patient properly (varies with the type of emergency) and make sure they are breathing. Ensure that airway and circulation are adequate. Be prepared to administer basic life support and cardiopulmonary resuscitation (CPR) as necessary.
2. Dial 911, monitor vital signs (pulse, respiratory rate, and blood pressure), and assess the level of consciousness.
3. Notify both the attending faculty and the Director of Compliance by calling 1-3083 or 405.473.6064. The supervising clinic faculty must remain with the person needing emergency treatment, as they are responsible for the life support of the person until appropriate help arrives.
4. Obtain a medical emergency cart.
5. Complete an Emergency Treatment Record form located in the emergency cart.

1. If you suspect the visitor/patient is having a cardiac arrest (not breathing and/or no pulse), CPR should be instituted immediately and a bystander should retrieve the Automatic External Defibrillator (AED) from the nearest location (South hallway on 1^st floor and north hallway on floors 2-5).  Notify the clinic faculty.
2. The student/resident will Call 911, Campus Police will ask the following questions: 
   a.  Nature of emergency
   b.  Identify the College
   c.  The floor 
   d.  The room/clinic number
3. Remain on the telephone until the EMS arrives.
4. Send someone to the 1st-floor main entrance to meet the EMS.
5. Inform the Director of Compliance by calling 1-3083 or 405-473-6064 as soon as possible.
6. Document the specifics of the emergency and the actions taken in the patient’s electronic health record (EHR). Document all medications dispensed, dosage, route, and time on the Emergency Treatment Record (see Section 5.2.12) located in the medical emergency cart. Give a copy to EMS when they arrive and keep a copy for our records. This will be scanned into the EHR.
7. Following proper disposition of the emergency, the healthcare provider (student, staff, resident, or faculty), and the attending faculty member must prepare a detailed report of the incident including names, dates, times, circumstances of occurrence, treatment rendered, condition of the patient, and final disposition of the case on a Clinical Incident Reporting Form (see Section 5.2.12). Provide this report to the Director of Patient Relations and Director of Compliance. A copy of the report will be forwarded to the Dean’s Office.
8. Suppose a patient reports an adverse incident to the healthcare provider or the patient service coordinator (PSC) by telephone during off-hours. In that case, the incident needs to be documented in the patient’s EHR and reported to the Director of Compliance the following business day. 
9. Neither the healthcare provider nor the faculty involved should make any statements to the patient regarding the final disposition of any medical, ambulance, and treatment fees. All documentation will be forwarded to the OUHSC Office of Risk Management, which will assist the visitor with additional questions.

Report all accidents or medical events, whether emergency or non-emergency in nature. Call 911, if necessary, and report the incident to the Director of Compliance (DOC) in Room 234, by calling 405-271-3083.

If an accident (for example; falling down the stairs or falling in or around the building) occurs to a visitor or patient not involved in dental treatment, contact the DOC and/or the Campus Police at 405-271-4911 to investigate.

Examples of an accident or incidents while providing treatment are:
a.  Cutting patient lip/tongue
b.  Wrong site surgery/procedure

1. Procedures to follow are:
   a.  Alert your supervising faculty
   b.  Call the Office of Compliance for assistance at ext. 1-3083 or 46876. If unavailable, call the Director of Patient Relations at 34031.
2. Document on Clinical Incident Reporting Form.
3. The form goes to the Office of Quality Assurance and Compliance, Room 238.
4. The Director of Compliance will assist in providing appropriate emergency care if the patient needs it.

The Director of Quality Assurance and Patient Relations will help provide an appropriate administrative response to the incident. 

This report is confidential, protected by the work product and peer review privilege, and intended to record an incident that may expose the OU College of Dentistry to liability.  The Clinical Incident Reporting Form is prepared in anticipation of litigation and may be discoverable in any future litigation. To protect this privilege, please:

1.   Disclose this report only to the following persons authorized to review it:

Director of Compliance
Director of Patient Relations
Assistant Dean of Clinical Affairs

2.   Do not disclose this document to unauthorized persons (including patients).

3.   Do not mention or place it in the dental record.

4.   Do not photocopy, fax, or duplicate in any form the completed report.

This document will be kept on file in the Office of Quality Assurance and Compliance, Room 238.

The Clinical Incident Reporting Form should be completed in situations where clinic outcomes of treatment are less than desirable. Supervising faculty should assist students in completing this form and signing it prior to submission.  The Office of Quality Assurance and Compliance will keep this document on file at the College of Dentistry.

The Clinical Incident Reporting form is available in all clinics in the Clinic Binder. The “official” Clinic Binder is now available in axiUm. The location is axiUm/Links/Clinic Binder.

INSTRUCTIONS FOR COMPLETING THE CLINICAL INCIDENT REPORTING FORM

A student, practitioner, or faculty member shall complete this report when an incident that causes a negative response by a patient or family member occurs or is suspected to occur.  All sections should be completed as applicable.  

Demographic information:  Please include ALL information regarding the patient record, those people involved, and the clinic in which the incident took place.  Indicate if informed consent was obtained in written or verbal form.

I.   Occurrence: Include a concise description of the incident and the names of any other individuals who witnessed the incident; if additional space is needed, the back of the form may be used.  All written reports should only contain facts and should not include opinions, conclusions, or judgments.

II.  Discovery: Indicate all individuals that acknowledged the incident, including the patient, family members of the patient, or a person escorting the patient.  Provide a description of the information given to this person(s) and indicate whether a prognosis and any follow-up care were discussed.  Be certain to indicate the patient’s understanding of the explanation for the cause of the incident and their satisfaction with that explanation.  If a resolution was proposed to the patient include a description of the terms discussed.

III. Resolution: Indicate who INITIALLY offered reimbursement to the patient. Supervising clinic faculty should indicate who requests reimbursement for approval by Clinic Operations (either Supervising Faculty or the Department Chair). Be certain to indicate in the “Patient’s Comments” any questions or remarks made by the patient in response to the terms of reimbursement. Additionally, a description of any arrangements such as remakes, special arrangements for treatment in other clinics, etc. should be included in the section on “Arrangements Made…”.  “Additional Comments” should include a brief discussion of the patient's concerns regarding how the situation was managed and any remarks that may be the result of a conversation with a family member or person escorting the patient.   

BOTH FACULTY AND STUDENT OR PRACTITIONER MUST SIGN THE REPORT AND DATE OF COMPLETION

A copy of the treatment progress notes from the patient’s dental chart must be attached to the form and returned in an envelope marked CONFIDENTIAL to the Office of Quality Assurance and Compliance, in Room 238.

This form will be available in all clinic faculty offices and should be completed immediately following the incident. 

Upon receipt, the Office of Quality Assurance and Compliance will review this form with the appropriate departmental faculty to determine a course of action and prevent future incident recurrence. Students and faculty should refer any further communication from the patient regarding the incident to the Director of Patient Relations. This report shall be shared with the OUHSC Office of Legal Counsel and the OUHSC Campus Risk Management Office.