Having been one of the first dental nurses to have experienced a second lockdown whilst working in Leicester, Louise Smith, of the Society of British Dental Nurses, offers some insightful advice to help dental nurses find their way through any storm that lies ahead

In the week ending 14 August, the number of deaths in England and Wales involving COVID-19 decreased for the 17th consecutive week.

However, we have been warned that without continued government action and public vigilance, we could be faced with a second wave of COVID-19 infection this winter that could cause 120,000 deaths.

Indeed, NHS leaders are already bracing themselves for a very challenging winter and senior Government advisers have warned that a second national lockdown could be imposed as the upper limit of the R rate pushed over one for the first time since restrictions were lifted.

This second wave is likely to overlap with seasonal influenza and all other infections that predominate during the winter months, so how will this impact dental teams?

Louise Smith, of the Society of British Dental Nurses, is Leicester based and was the first to go into a second lockdown.

Since then, other regions have looked at the Leicester experience to guide them in writing second wave Standard Operating Procedures (SOPs) and adjust again.

Here, Louise share some invaluable insight…

What may we learn as dental nurses from the first wave of COVID-19?

ν That we are good at working as a team.

ν We are strong and capable of leading the team in infection control

ν We are adaptable and flexible under pressure.

ν Our ideas and suggestions are invaluable to the process of setting up clinics from a COVID-19 perspective. We will look at things differently to the clinician.

In theory, will the second wave be more straightforward in how to respond, having gone through it once already?

We will be more prepared as we are all doing what we should be doing to keep our patients and colleagues safe with current guidance.

Are there any parallels we may draw upon?

I don’t think we’ve had anything like this in my lifetime. Even swine flu never evolved to this level. Even though we started to prepare when swine flu came about, we could never have imagined the preparation involved and how it would affect us all individually with COVID-19. The effects will remain with us for many years to come.

How useful is social media and digital communications in preparing our patients? For example, a lot of dental practices are offering virtual consultations and, if we have a second wave, which of these can continue to be handled safely and remotely?

Social media and digital communications especially have been invaluable in communicating with patients and also our colleagues. Lots of practices are filming videos to send to their patients to prepare them for their dental visits.

As visiting the dentist can be scary for some, videos are informative and deliver clear instructions on how we all will be operating our clinical deliverance of care. Additionally, virtual consultations are key in the current climate. We need to retain communication with patients and discuss their needs and expectations. We need to be honest as a service about what we can realistically deliver, as well as manage expectations regarding timelines of treatment and future treatment plans.

Should we be looking at how to maximise the benefits of triaging?

Triaging patients is also key in delivering care to our patients. Within a dental service, everyone can play a part in how we triage our patients – the dentists, dental hygienists and therapists, dental nurses and even the admin team. There also needs to be a Standard Operating Procedure (SOP) in place for what you expect each member of your dental team to deliver. Without this written down for teams to reflect on, they might be confused about their role and lost without a structure.

Should we plan how we will stay connected with our team in order to maintain confidence and morale?

Regular huddles before and after clinical sessions is a good tool to have in place. This can be time consuming, but maybe going forward only having debriefs when there is something to discuss can save time.

Regular Zoom meetings with your team enables managers to discuss how the business is doing and gives everyone an opportunity to brainstorm ideas.

Setting up WhatsApp groups to relay information can also be a good tool for informal chats. For more formal discussions, email is probably a better way to communicate. Practice managers might like to send out a monthly or quarterly newsletter email, informing the team on what has gone well and not so well, such as patient waiting lists of treatments and outstanding recalls.

Is patient feedback important at this time?

If you have a text system in place at your practice, asking patients for feedback would be an ideal way of collecting this data. If you don’t have this luxury, give the patient an email address and invite them to reflect on their appointment.

What thoughts regarding meetings to discuss contingency plans?

It can be quite demotivating when it’s just one person making all the decisions so it is always good to involve the team in ideas that they could contribute in the set up and running of the clinics. Whether the principal chooses to accept ideas is another thing but listening to your team will get the most out of their performance. Having a back-up plan in place for various aspects will prevent a panic when things go wrong. Again, writing SOPs is just one contingency plan to have in place.

Should teams be reflecting on the first wave and how they can do better?

I think it is important throughout any transition in the way we deliver services to reflect on a daily basis and change what may not be going well and feed any changes out to the team once it is established how best to move forward. That way, if we face a second wave we will be better prepared to cope with flexibility.

Should we be encouraging patients to change up their diet re: nutrition/vitamin D as a preventative measure?

Dental hygienists and therapists and dental nurses are your golden ticket to getting this information out to patients. Toothbrushing videos, for example, are such an invaluable tool – but this is just one idea of what videos you could put together as guidance for your patients.

Should teams be discussing mental health vulnerability within the team/of patients?

Mental health should always be discussed in a confidential manner. Signposting patients and colleagues is important in guiding them to source help and support.

Should dental nurses be thinking about what they learned from the first wave?

Yes, dental nurses like other dental professionals have had it hard. There have been dental nurses who have been furloughed, who have had to shield, who have worked all the way through and have had to battle different challenges. We are all steering our own ship and have to be mindful that the challenges and perception of other people’s circumstances may not be the reality.

If there is a second wave and we see further lockdowns, how can we mitigate against the impact?

We now know more than we did in the first wave so we can be better prepared and put some contingencies in place to deal with the backlash this may have.

Should dental teams be drawing up possible rotas to ensure social ‘bubbles’ and prevent the spread?

This is a good idea but may not be practical. What practices can do is have written guidance of maximum numbers of staff in areas to apply social distancing and infection control measures.

Small things like door handle wiping and moving computers and chairs two metres apart will ensure compliance of current measures.

Should teams be discussing processes to prioritise patients if there is reduced services?

Yes , a plan must be discussed and created on how you can safely deliver care, but still run a dental business that meets financial need and service deliverance.

Should teams be gathering social information in order to ascertain which patients are more likely to be shielding?

Triaging and/or RAG rating current patients to decipher who needs priority care may be a way of identifying shielding patients and so on. Good medical histories will help you treat your patients and having a good relationship with GPs can only be a good thing.

You can look back over what has been recorded historically and this may help in treatment planning.

What can be done about complex treatment plans?

Templates are very helpful. Having a standard treatment plan covering all variants of possible treatments can be a useful tool and, that way, you can simply delete the non-relevant sections. If it’s a digital amendable template, this is even better. You can easily add or delete what you do and don’t need.

What can dental nurses do re: ensuring adequate PPE?

Read the current guidance so you are doing your best to protect yourself and your patients. A lot of dental nurses I’ve seen and read about on social media are scared to speak up for themselves for fear of being reprimanded. It saddens me to think there are dental nurses who do not feel safe in their workplace.

Should dental nurses consider practising and fine tuning infection control protocols? How important is it to stay up to date with current guidelines?

Staying up to speed with infection protection and control guidelines is vital. We should always seek ways to ensure patient safety and consider any areas for improvement, such as decluttering rooms or providing alternative waiting areas to allow improved social distancing. Order cleaning supplies, including hand sanitisers and so on. If you think of something that could work better in your practice or you see a money-saving aspect, speak up. I know it’s scary, but I always suggest dental nurses find someone within their workplace in whom they can trust and turn to. It may be a mentor, a practice manager, or even the principal dentist?

Consider putting up laminated signs that can be wiped – these will support your colleagues when information is hard to remember, such as the correct protocols for donning and doffing. If you are unsure if something is right or wrong, contact the Society of British Dental Nurses – this is what we are here for.

How is the SBDN preparing?

SBDN has been supporting members and non-members all the way through the pandemic. Providing information webinars, having a dedicated telephone line, and answering questions posted on social media are some of the ways we are helping. However we have come through so far together.

What can SBDN offer its members should we face a second wave?

We are always here for our members and will continue to reflect on the current situations in which we find ourselves in order to find a way through the storm that is ahead.

We have to remain together and help each other and remember our support network tree of SBDN. We don’t all know the right answers but we have an amazing network team who we can call upon when needed for guidance and support.