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We Tackle Coronavirus Dental Compliance Questions - Dwight Shreve

Aug 7, 2020

In this episode of Talking with the Toothcop, Dwight Shreve joins Andrea and I to cover some of the most-asked questions that have accumulated during the Coronavirus pandemic. We talk about face masks and respirators and how to use them properly. We also talk about addressing issues in your practice and the proper procedure if a staff member is diagnosed with COVID-19. If you have unanswered questions swirling around in your head, don’t miss this episode!

Dwight Shreve worked at Crosstex for a couple of years as a Sales Manager and Infection Prevention Advisor. Now Dwight is an Independent Consultant with us at Dental Compliance Specialists. He has a passion for supporting patients and helping to make sure their needs are being met. 

Outline of This Episode

  • [0:21] Andrea and I are joined by Dwight Shreve
  • [1:58] Lockdown in Texas has been lifted
  • [3:20] What is a face mask anyway?
  • [7:02] Guidelines to follow in dentistry
  • [12:17] Respirator Medical Evaluation Questionnaire
  • [15:35] Complete a respirator fit test
  • [18:56] The pandemic uncovered a rift 
  • [30:00] CDC return to work Criteria for staff
  • [32:52] Do I have to pay my staff PTO?
  • [34:28] Just because you don’t HAVE to do something…
  • [35:45] Texas Dentists: get consent for every procedure you do
  • [45:42] Surround yourself with a good team

The difference between face “coverings” surgical masks, and respirators

A face covering—which is being mandated almost everywhere right now—can be a bandana, a neck gaiter, or a homemade mask made of whatever fabric you have on hand. There are surgical masks (level 1, 2, or 3) and then there are different types of respirator masks such as N95 and KN95 masks. They are regulated by the FDA and the use is mandated in certain environments. 

One of the biggest questions I get is, “Do I have to do it, or is it recommended?” Currently, this is federal law and stuff you HAVE to do. OSHA has standards (which are effectively law) and they have guidelines that are recommended (you should do it). If you don’t do it? The bottom line is that you can get in serious trouble. 

Everyone working in a healthcare environment—even the dental office—should be wearing a surgical-grade face mask—NOT a face covering. You must focus on prevention to minimize the impact on the practice if someone is diagnosed with COVID. Why is it important? Listen to hear our discussion on the topic!

Dentists: You HAVE to use a respirator correctly!

Did you know that before you even put a respirator on, you’re supposed to have a medical evaluation and a fit test? If you haven’t done that yet—go back and get it done. OSHA provides a medical questionnaire for the medical evaluation that should be completed for each staff required to use a respirator mask.

The evaluation needs to be completed by a licensed healthcare provider. I suggest you send your staff with the eval to get cleared by a physician (to control your liability). Why is it important? If you are not medically fit to be wearing a respirator then you shouldn’t be wearing one. In some instances, that means you cannot carry out the duties of your job. Only once a staff member is medically cleared do they get fitted for a respirator. What does that look like? Listen to find out!

Address issues that can negatively impact your practice

You have to look at issues that crop up for the potential that they have to dramatically and negatively impact your practice. You need to be proactive and look at things in advance while anticipating and weighing the risk versus benefit of applying a protocol—or disregarding the protocol and just continuing as is. Sometimes you have to put your personal feelings aside about things and do what's in the best interest of your practice.

You have to implement these steps so you can defend yourself if someone does get sick and it’s linked back to you. it's always easier to prevent problems than it is to deal with them in the aftermath. Andrea emphasizes that there are laws and regulations in place you have to follow regardless of how you feel about the situation. Dwight points out that “Your practice is only as safe as your patients perceive it—and perception is reality right now. So if your patients don't perceive it's a safe environment to be in, they're not coming back.”

What can you do to encourage open communication? Listen to find out. 

Current guidelines on a team member who contracted COVID

Another question that we’ve been asked frequently is: We have a staff member that’s sick, what do we do? How long until they can come back? Do we require them to get tested? 

As of July 17th, 2020 changes were made to the guidelines to conserve tests. So the CDC is moving away from requiring tests to return to work and simply monitoring symptoms. There are three requirements a staff must meet to return to work: 

  • There needs to have been at least 10 days since symptoms have first appeared AND
  • At least 24 hours must have passed since the patient has had a fever AND
  • Symptoms such as cough and shortness of breath must be improved

The guidelines will likely change again, but you need to be familiar with them. Who pays for the tests—the employer or the team member? Listen to hear our answer. 

A Note for Texans Participating in Medicaid: Get Consent

While this applies most specifically to my Texan listeners, I believe every dental practice should embrace these procedures. 

Make sure you have consent forms for every single procedure you carry out, for every patient, every time. This includes preventative procedures and things you don’t normally need to get consent for (fluoride treatment, x-rays, etc.). You must also make sure your clinical notes and all chart documentation reflect the service you’re providing. If it’s not written, it didn’t happen, and it will be presumed fraud. 

Ignorance is bliss—until you get caught. Get auditing and monitoring processes in place to make sure your clinical charting is being done properly. Dwight implores you to get your house in order and keep up-to-date on compliance issues. Dentists may not have known what they signed up for when it came to all the business aspects of dentistry but they’re all inherently important to the small business that you operate and must be learned. 

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