231 - Enhancing Perioperative Care for Special Needs Dental Patients

Description: Clinical Problem/significance: Frontline staff identified OR start time delays and concerns to consistently deliver safe, individualized care to special needs patients. Staff expressed uncertainty and a lack of preparedness in addressing the unique needs of these patients, which contributed to workflow inefficiencies and compromised patient experiences.

Synthesis of Evidence and clinical question: The clinical question: How can more consistent individualized and safe perioperative care be provided to special needs dental patients. Bakas et al. (2015) emphasized the value of completing of an adaptive care screening tool prior to patient arrival, which enabled the development of a more individualized care plan. King et al. (2022) recommended that patients with special needs have an alert in the EMR to facilitate early identification by the multidisciplinary team. Selvey et al. (2019) supported the use of pre-procedure telephone screenings involving caregivers to identify triggers and calming techniques that are specific to the patient.

Description and Implementation of Evidenced-Based Strategies: A procedural plan template was created and integrated into the EMR which includes a series of targeted questions for primary caregivers to complete before the patient's arrival. Once submitted, the information triggers a flag in the EMR, alerting all members of the care team to the patient's specific needs. Additionally, a "Get to Know Me" tip sheet is given to caregivers to complete upon arrival. This document travels with the patient through all phases of care, ensuring that individualized information is consistently communicated across the multidisciplinary team. Staff received training through visual aids and detailed instructions to ensure proper use of these tools and promote adoption.

Results: A pre-implementation survey of revealed 80% of staff experienced challenges in providing safe care to the special needs patients. Additionally, only 58% of the scheduled procedures began on time. Following the implementation of the new workflow tools, on-time OR starts improved to 71% over one-month, bringing them closer to the overall goal of 80%.

Conclusion and Perioperative Nursing Implications: The integration of early identification tools within the EMR and the use of caregiver-informed documentation have significantly improved perioperative care for special needs dental patients. These strategies have led to reduced delays, enhanced communication, and increased staff satisfaction. Most importantly, they have contributed to safer, more personalized care. Ongoing evaluation and refinement of these processes will be essential to achieving the 80% on-time start goal and sustaining improvements in patient outcomes and staff experience.

References:

Balakas, K., Gallaher, C. S., & Tilley, C. (2015). Optimizing Perioperative Care for Children and
Adolescents with Challenging Behaviors. MCN, the American Journal of Maternal Child
Nursing, 40(3), 153–159. https://doi.org/10.1097/NMC.0000000000000124

King, T. A., & Duffy, J. (2022). Peri-operative care of elective adult surgical patients with a learning disability. Anaesthesia, 77(6), 674–683. https://doi.org/10.1111/anae.15691

Selvey, P., Stypulkowski, K., & Waisbren, S. (2019). Surgical management of the patient living
with autism. Surgery Open Science, 1(2), 90–96. https://doi.org/10.1016/j.sopen.2019.06.006