All pre-med clearances go through the specialist. I have a pt that has to take pre-med day before, day of and day after due to several joint replacements. We always leave it up to the specialist and have it in writing so there is never any confusions whether the pt still needs pre-med.
We have the surgeon or specialist give written orders on medical clearance and premed. The orders & clearance we receive are all different. I recently researched premedication before dental procedures as a project for class and there is nothing black and white when it comes to premedication. If a patient has had joint replacement, spinal surgery with fusion, etc., we attempt to reach physician while pt is in chair or reschedule until clearance & orders are given. We made a generic form for clearance and premed orders which makes it really easy to fax and the treating doctors office can complete & fax back. Put in patient’s chart and we are good to go. Premedication is frustrating sometimes and I wish the guidelines were more definitive!
In our office, total joint replacement premed is for lifetime unless their orthopedic Dr indicates otherwise.
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