Swallowing Foreign Objects Policy
Protocol for incidents involving patients swallowing various foreign objects associated with dental treatment - rubber dam clamps, burs, crowns, implant parts and pieces of broken instruments:
The provider will stay with the patient, monitor vital signs, observe for acute respiratory distress, and make a preliminary diagnosis from the clinical signs and symptoms and the patient's response to careful questioning.IN THE EVENT OF AN EMERGENCY CALL THE SCHOOL OF DENTISTRY EMERGENCY TEAM AT 537-3911 AND FOLLOW DENTAL SCHOOL EMERGENCY PROCEDURES.
The attending DDS should explain to the patient the purpose and procedure for getting radiographs. The provider will send another provider, staff assistant or student to the School of Dentistry's Radiology Department located on the 1st Floor of Tarrson Hall to obtain the Diagnostic Radiology & Imaging order (as long as an emergency condition does not exist, such as respiratory distress).
Inquiry needs to be made by the provider as to whether the patient has a UNC Hospital Medical Record (MR) number and make note of it. If not, or if the patient is unsure of their MR number, the provider, staff assistant or student should call the UNC Hospitals' registration office at 966-1234. Explain the necessity to expedite the call quickly. Registration information from the patient's electronic record will be required to register the patient. Make a note of the MR number to be given to the School of Dentistry Radiology Department. Instruct the patient that if they receive a bill from the hospital, they should forward it to the Office of Clinical Affairs.
Transportation to Hospital Radiology (x-ray) is the responsibility of the attending DDS or the designated assignee. Transportation for sedated (but not emergent) patients may pose special risks. Obtain a wheelchair from the ground floor Tarrson Hall, Dental Faculty Practice, Graduate Periodontics or Oral Surgery and transport the patient to the hospital.
When the radiology technician calls the patient back to take the film, ask to see the radiograph when it is ready in order to determine the location of the foreign object.
If the imaging reveals the patient ingested the object and an emergent situation does not exist, the patient should be informed to contact their medical provider to determine if follow-up radiographs or treatment is needed. If the imaging reveals the patient aspirated the object or an emergent situation does exist, the patient should immediately report to the emergency department and follow the treatment guidelines of the hospital medical provider.
Complete the UNC School of Dentistry's Patient Incident Report and forward it within 48 hours to the Office of Clinical Affairs (452 Brauer Hall).
The provider should document the incident in the patient's record. The notation should include the provider's recommendation for a medical evaluation, which includes radiographs. The provider should note whether the imaging results required the patient to report directly to the emergency department or whether the patient was informed of the necessity to follow-up with their medical provider to determine if follow-up imaging or treatment is needed. The provider should note all preventative measures taken to avoid the swallowing or aspiration of the object. Do NOT refer to the Patient Incident Report in the patient's record.
If a copy of the radiology report is needed, the provider should contact the ordering provider named on the Diagnostic Radiology & Imaging order.
If the patient refuses the radiographs, proper notation should be documented in the patient's record.
Last Modified: 07/07/2014