Overview

We managed admissions for 3 patients whose behaviour may have presented a risk to staff and other patients.

The patients had learning and mental health issues and needed day case dental treatment under general anaesthesia.

Preparation

Planning involved initial meetings between the patients carers, dental team, anaesthetists, learning difficulty lead nurse and hospital security.  Subsequently the patients carers visited the hospital to walk through the proposed pathway and identify potential triggers for challenging behaviour and risks of such behaviour.

Plan was made for managing behavioural problems including making security aware of need to be immediately available during admission.

Potential problems

  • Waiting
  • Unfamiliar environment
  • Unfamiliar people
  • Close contact and Interventions

The Plan

Decision made to isolate patients during admission by using Vanguard mobile theatre for treatment which has own direct access to anaesthetic room from parking area. Induction of anaesthesia was planned to take place on the floor on patients own blankets for 2 admissions as patients felt safer there. Scoop stretcher used for 1 admission and hover jack air patient lift on the others.

Intravenous induction of anaesthesia for each case with safe holding provided by patients carers.  Surgery took 1- 2 hours and patients were recovered in the anaesthetic room by anaesthetic team.

Once recovered, patients were discharged directly to their own transport waiting outside theatre doors.

Outcome

Each admission proceeded safely and uneventfully despite initial concerns.  We felt use of a Vanguard theatre and devices to lift these unconscious patients from the floor were helpful in achieving successful outcome in potentially challenging circumstances.

 

Published with thanks to Consultant Anaesthetist. Anna Lipp