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Forgot to ask if patient needed premed

Backstory on what triggered my anxiety: prior to srp the other hygienist advised the patient to take premedication because she had knee replacement years before prior. I did sc/rp first half a few days before. i didnt ask because as far as guidelines I know its not required anymore. when the other hygienist asked for a premed, the office manager asked her why? The manager also is aware that its not required anymore prior to Prophy. Then she consulted our dds and dds told her its not required unless her orthopedic instructed her to do so. The pt said she doesnt remember about such instructions. They ended up giving her premed from the office anyway. Idk maybe just to be sure. Its my fault for not knowing. Lesson learned even if its not required, i should always ask. Which leaves me to this question. Will I get sued for not asking? Also I admit it, it gets busy in the office sometimes that I skim thru medical hx and im so used to normal health hx or people only checking diabetes, hbp, the common problems that i forget paying attention to joint replacements. It also got instilled in my head that theres no need for premed anymore that it makes me wonder and doubt myself if im paying attention to those patients that really needed premed. Like ones with artificial valve and stuff. No one has reported me yet for forgetting to ask. My anxiety i causing me to think that one day they will realize it and i will get sued for not asking. I know as hygienist we tend to miss stuff heck once i even forgot to put a lead apron on a patient. Help 🙁 should i quit hygiene because of the fear of being sued or should i learn from this mistake and know that its not a perfect world and people make errors. Coz if i ended up not paying attention to the ones that really needed it, this is like an error thats kinda unacceptable no? 🙁 help sorry for the long question description. I havent been able to sleep 🤪



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2 Answers

I’m sorry you are losing sleep over this! While the ADA does not recommend premed for joint replacement, in my opinion, it’s always best practice to check with the patient’s surgeon for their instruction and recommendation. I would never suggest relying on a patient to remember, or not, what their surgeon recommended. Further, I would recommend getting the surgeon’s premed recommendation in writing and save it in the patient’s chart. Many offices not only check with the surgeon for clearance and premed recommendation but have the surgeon prescribe the premed if it’s needed.
 
All patients are different and have different health histories, so there is no cookie-cutter, one-size fits all answer, as the ADA makes it out to be. Case in point, while the ADA does not recommend premed for joint replacements, a family friend of mine had an ankle joint replacement. It became severely infected, and he had to undergo additional surgeries. The definitive cause was oral bacteria from a decayed tooth that had abscessed. My point is, while many patients don’t need premed, some might depending on their health history and knowledge of the replacement surgery that only the surgeon knows. While I suspect this is rare, it can happen.
 
It is not my intent to give you more anxiety or stress, but you asked for an answer, so here it goes. While I’m not an attorney, it is my understanding hygienists can be sued independently or named in a lawsuit against a doctor. The top reasons for hygienists getting sued are a failure to detect oral pathology, failure to detect periodontal disease, injuring a patient, and failure to update medical history, including asking if a patient has premedicated (if they should have).
 
On a side note, though you may be covered under your doctor’s malpractice insurance, it’s wise to have your own policy. Malpractice insurance is relatively inexpensive, and the peace of mind it brings can be priceless. I believe I pay under $80 per year through Proliability.
 
With this said, I doubt there’s a huge possibility your patient will suffer negative effects from not being premedicated. There is always a risk though, so being thorough all the time, every time, is a must. I must mention, I’m not an orthopedic surgeon and don’t know this patient’s health history, so this is a complete assumption.
 
So should you quite hygiene? No! To be honest (again), even if you “quit” you could still be held liable. Again, not saying anything is going to happen, and you will be held liable, just saying that quitting isn’t the cure-all to alleviate all of your risks.
 
I do want touch on you “hurrying through health histories.” Are you not given enough time for appointments, which is what makes you in such a rush to not be thorough? If so, this is something you need to discuss with your boss/doctor. Rushing through health histories, treatment, etc., like stated above, has the potential for you to make mistakes, miss things, and doesn’t allow you to give thorough treatment, which puts both you and the doctor at higher risk for liability issues and lawsuits. It’s also not great as far as patient care goes either. Personally, I wouldn’t work at an office that put my license at risk. It might also be a good idea to chat with the doctor about your concerns over this and get their input.
 
I’m sorry if my answer doesn’t alleviate your anxiety. On the bright side, if you learn from this and make the necessary changes, you can sleep well knowing you did as much as you could to keep your risk for liable action from a patient low.

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Thank you so much for taking the time to respond. i really appreciate it. Amidst all the anxiety and lack of confidence, i feel like this has made me realize i should be a better clinican. i must change my ways and this definitely has become a big big wake up call. Im glad no one has called and complained. I really usually dont get complaints as i try my best to satisfy my patients. This experience and awakening probably saved me from future harm. i’m definitely should not settle in mg comfort zone and keep learning from my mistakes big or small. Thank you for all your help. I aspire to become as knowledgeable as you. Have a good week ahead Kara.

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