The management of pain – some additional issues
Originally published in the November/December 2016 issue of Dispatch
This is the last of four articles aimed at raising member awareness and knowledge of the College’s Guidelines on The Role of Opioids in the Management of Acute and Chronic Pain.
The management of pain is an important component of dental practice. Dentists frequently consider the use of analgesics and other drugs to manage the patient’s condition, which requires appropriate knowledge, skill and professional judgment to be effective and maintain safety.
Before prescribing any drug, dentists must have current knowledge of the patient’s true health status and clinical condition. This can only be acquired by obtaining a medical history and conducting an appropriate clinical examination of the patient in order to make a diagnosis or differential diagnosis, or otherwise establish a clinical indication for the use of a drug. There must be a logical connection between the drug prescribed and the diagnosis or clinical indication.
When prescribing a drug, dentists must provide:
- name of the patient
- full date (day, month and year)
- name of the drug, drug strength and quantity or duration of therapy
- full instructions for use of the drug
- refill instructions, if any
- printed name of prescriber
- address and telephone number of dental office where the patient’s records are kept
- signature of prescriber or, in the case of electronically produced prescriptions, a clear and unique identifier, which indicates to the dispenser that the prescriber has authorized the individual prescription.
If the prescription is for a monitored drug, as defined in the Narcotics Safety and Awareness Act, 2010, dentists must also provide their registration number, as well as an identifying number for the patient (e.g., health card number) and the type of identifying number it is (e.g., health card).
Written prescriptions must be legible. It is recommended that dentists use the generic name of the drug to ensure prescriptions are clear and consider including more information when appropriate (e.g., include both brand name and generic name, and the reason for prescribing the drug). When writing prescriptions, dentists must pay particular attention to the use of abbreviations, symbols and dose designations. Avoid using abbreviations, symbols, and dose designations, as their use has been associated with serious, even fatal, medication errors.
When issuing written prescriptions for opioids, take the following precautions:
- If using a paper prescription pad:
- write the prescription in words and numbers
- draw lines through unused portions of the prescription
- keep blank prescription pads secure.
- If using desk-top prescription printing:
- use security features, such as watermarks
- write a clear and unique signature.
- If faxing a prescription:
- confirm destination and fax directly to the pharmacy, ensuring confidentiality;
- destroy paper copy or clearly mark it as a copy.
Verbal prescriptions must be communicated in a clear manner. The more direct the communication between a prescriber and dispenser, the lower the risk of error. Accordingly, if dentists use verbal prescriptions, it is recommended that they communicate the verbal prescription themselves. If this is not possible, it is recommended that dentists consider asking a staff person who has an understanding of the drug and indication to communicate the prescription information, unless the prescription is a refill.
Drugs stored in a dentist’s office should be kept in a locked cabinet and out of sight. Dentists are advised to avoid storing drugs in any other location, including their homes. Never leave drug bottles unattended or in plain view. A drug register must be maintained that records and accounts for all opioids, as well as other narcotics, controlled drugs, benzodiazepines and targeted substances that are kept on-site. The register should also be kept in a secure area in the office, preferably with the drugs, and reconciled on a regular basis.
Use staff training sessions and meetings to discuss the dangers of drug and substance abuse. Remind staff of the safeguards and protocols in the office to prevent misuse of supplies and provide information about resources that are available to dental professionals to assist with wellness issues. Emphasize that dentists and their staff must not access in-office supplies of opioids, or other drugs that normally require a prescription, for their own use or use by their family members. Always take reasonable precautions to prevent the unauthorized use of in-office supplies of opioids or other drugs by staff and others with access to the office.
Dentists should be aware that pharmacists are responsible for confirming the authenticity of each prescription, which may require direct confirmation with the prescriber before the prescription is filled.
ARTICLES ON THE NEW GUIDELINES
These other articles explain more about the College’s Guidelines on The Role of Opioids in the Management of Acute and Chronic Pain in Dental Practice, the first dental guidelines of their kind in Canada.
Part One: The management of acute pain