During a recent webinar on Risk Management for Oral Health Practitioners, we had the pleasure of hosting guest presenter Sinead Wright, an experienced Oral Health Therapist and clinical educator. Her valuable insights on scope of practice and informed consent proved to be highly informative.
Due to time constraints, some member questions couldn't be addressed during the live session. Therefore, we have compiled the following information that covers key themes relating to those outstanding questions.
If you require assistance or have questions about a specific circumstance, please don't hesitate to reach out to MIPS advisors at 1800 061 113.
Scope of Practice
Medicare provider numbers
Since 1 July 2022, dental hygienists, dental therapists, and oral health therapists can access Medicare provider numbers to directly claim for services under the Child Dental Benefits Schedule (CDBS), raising the question of OHTs working independently without dentists.
Practicing under your provider number is possible under Medicare, but the situation may differ with health funds due to their individual business rules. It is advisable for OHTs to verify with the relevant health funds in advance if their provider number and item number are accepted for claims. Failing to do so could lead to complications for both the practitioner and the patient.
Read more in the Australian Government Department of Health factsheet which explains how to apply for a Medicare provider number, the services that can be claimed, and where to find more information.
Business legalities for independent practice
When working as an independent practitioner, OHTs must consider the business legalities associated with performing certain procedures, such as taking radiographs and administering local anaesthesia (L.A.). It is crucial for OHTs to assess their scope of practice and ensure they possess the necessary qualifications, skills, and knowledge for the procedures they undertake. This self-assessment is vital as it enables them to substantiate their capabilities to regulators or in legal proceedings if ever required.
Additionally, OHTs operating their own practice or premises should consider whether they might benefit from obtaining public liability insurance. This covers liability for public liability incidents – for example, where a patient is injured from a hazard that you have negligently created in the workplace. More information can be obtained from a general insurers or brokers. This type of insurance package typically includes coverage for fire, contents, equipment, and public liability.
Regaining Competence
If you haven't practised a skill recently, you may wonder how to regain your competence. Ensuring you have the fundamental qualifications, skills, and knowledge is essential and should be kept up to date. Observing a colleague's performance or enrolling in a relevant course are both valuable options to consider. By doing so, you can refresh your understanding and proficiency. Ultimately, confidence in your abilities is vital, as it enables you to substantiate your appropriate scope of practice if ever challenged.
Informed Consent
When it comes to advising on informed consent, MIPS relies on the Dental Board's code of conduct as a valuable resource. As your conduct will be evaluated against this code, incorporating its guidelines in your decision-making process will help uphold ethical standards and foster the highest level of care for your patients.
Guidelines for best practice
Informed consent is a crucial aspect of healthcare, representing a person's voluntary decision made with a comprehensive understanding of the associated benefits and risks. Practitioners seeking guidance on providing patients with the necessary information can refer to the National Health and Medical Research Council (NHMRC) publication titled "General Guidelines for Medical Practitioners in Providing Information to Patients". These guidelines cover essential areas such as detailing proposed management or approaches, especially where risks of harm are more substantial and offering advice on effective information presentation.
Adhering to good practice involves several key principles:
Communication with Clarity: Practitioners should present information in a manner that patients can easily comprehend before seeking their consent.
Informed Consent: Prior to conducting examinations, investigations, treatments, or involving patients in research or teaching, obtaining informed consent or valid authority is essential. However, in emergencies, this may not always be possible.
Transparent Cost Communication: When referring patients for further investigations or treatments, practitioners should inform them about the possibility of additional costs, allowing patients to seek clarification before proceeding.
Consent for Impaired Patients: When dealing with patients whose capacity to give consent may be limited or impaired, obtaining consent from individuals with legal authority to act on their behalf is crucial. Practitioners should also attempt to secure the patient's consent as much as practically possible.
Documenting Consent: Proper documentation of consent is vital, especially for procedures that carry a risk of serious injury or death. Consideration should be given to obtaining written consent in such cases.
Fees and financial consent
Establishing clear and transparent communication with patients is of paramount importance, and a crucial aspect of this communication is the disclosure of fees and obtaining financial consent from patients or clients. Prior to providing any health service, it is imperative to ensure that patients or clients are fully informed about all the fees and charges associated with their course of treatment, including out-of-pocket expenses where Medicare is billed.
Engaging in a professional discussion about fees is equally essential, as it ensures that patients understand the costs of all required services and enables a mutual agreement on the level of treatment to be provided. By adhering to these principles, healthcare practitioners can foster trust and facilitate a patient-centered and financially transparent healthcare experience.
Children and young people
Caring for children and young people entails additional responsibilities for practitioners, and adhering to good practice involves the following key principles:
Placing the interests and well-being of the child or young person as the top priority.
Considering the young person's capacity for decision-making and consent. In cases where practitioners ascertain that a person possesses sufficient age and mental and emotional capacity to give consent to a service, that individual should have the right to request and provide informed consent for receiving services without the involvement of a parent, guardian, or legal representative. However, where parents disagree about treatment and the practitioner believes the child is capable of consenting, it would be wise to seek a second opinion about the child’s capacity and the proposed treatment.
Ensuring respectful and effective communication with children and young individuals. Practitioners should treat them with respect, listen to their views, encourage questions, and provide information in a manner that they can easily comprehend. Additionally, acknowledging the role of parents and, when appropriate, encouraging the child or young person to involve their parents in decisions about care are vital aspects of good practice in paediatric healthcare.
When a child is not capable of consenting to treatment and parents disagree about treatment, it can be difficult to know how best to respond. In these situations, practitioners are strongly encouraged to seek legal advice and support, to ensure that they comply with your legal obligations.
By following these principles, healthcare practitioners can ensure the well-being and active involvement of children and young individuals in their healthcare decisions.
Additional Resources
Dental Board AHPRA - Codes and guidelines
MIPS dental practitioner education - 1hr online modules
More information
If a member has concerns regarding risk management and requires clinico-legal assistance, contact MIPS on 1800 061 113
