Avoid Medication-Related Tragedies with Comprehensive Health History Forms

Take two of these and call me in the morning. That may have been sage advice a generation ago, but today, dispensing medication requires much more scrutiny. Americans are taking more prescription drugs than ever before, meaning health professionals, including dentists, must use extra precaution when dispensing and prescribing routine medications as part of an overall treatment plan.

The Dentists Insurance Company reminds dentists that the greatest ally in preventing negative drug interactions, allergic reactions or other adverse effects is a patient’s health history form. An accurate, up-to-date, comprehensive health history gives dental practitioners the data they need to make informed treatment recommendations — including those that incorporate medication or prescription-strength dental products.

Unfortunately, incomplete, outdated or missing health history forms can lead to tragedy. In one case reported to TDIC’s Risk Management Advice Line, an 11-year-old patient died after suffering an allergic reaction to a prescription-only toothpaste dispensed by the dentist. The patient had come in for a routine exam and teeth cleaning. The dentist noticed the presence of extensive decay throughout her mouth, so he dispensed a prescription-strength toothpaste to use at home. Two days later, the dentist learned the patient had suffered from anaphylactic shock and died.

The patient’s medical doctor alleged that the milk-based proteins in the toothpaste contributed to the patient’s death, as she had a lactose allergy. However, her parents had not disclosed the lactose allergy to the dentist at the time of the appointment. The patient had not been seen in five years and her previous health history could not be located after the practice transitioned to a digital record-keeping system.

Senior Risk Management Analyst Taiba Solaiman said this tragic case is a reminder that a patient (or a patient’s parent, if the patient is a minor) should review, update and sign a health history form at every appointment. Dentists should then review the form prior to treatment. If the form is missing, a new form should be filled out and signed prior to initiating treatment.

“The patient’s signature serves as evidence that the information is current and the patient’s health was discussed,” Solaiman said.

Health history forms should contain questions about over-the-counter medications, prescribed medications and supplements, among others. TDIC provides sample health history forms in English and Spanish at tdicinsurance.com/sampleforms.

Dentists should verify the information in the patient’s chart by speaking to the patient directly. Often, patients don’t recognize the link between overall health and oral health nor do they recall every medication they take, especially if they haven’t been seen recently. The following questions should be asked when updating a patient’s health history form:

• Have you sought care from other health care providers since our last visit?
• Have you visited the emergency room or been hospitalized since our last visit?
• Have you begun, discontinued or changed the dosage of medications (prescribed or over-the-counter)?

A complete health history reveals crucial information about health conditions and medications that could affect dental treatment. It could also alert a dentist that dental treatment could affect a patient’s health condition.

Additionally, staff should immediately inform the dentist of any changes to a patient’s health. Attention to a patient’s medical and dental condition shows concern for their well-being and thus strengthens patient confidence in a dental practice’s treatment ability.

If dentists are dispensing medication, it’s essential they are familiar with the medications (and products) they are dispensing and know the interactions, side effects and contraindications of each. Patients may not always be aware of the ingredients contained in dental products (such as milk proteins in a toothpaste), so the onus is on the dentist to educate them. For example, some dental products, such as prophy paste and fluoride gel, contain gluten and may cause a reaction to gluten-sensitive patients.

“Dentists should take dispensing and prescribing medication seriously,” Solaiman said. “Adverse reactions can and do occur and even something as seemingly benign as toothpaste can have a devastating outcome.”

Typically, pharmacists advise patients of the possible side effects and contraindication of medications. In-office dispensing takes the pharmacist out of the review process. Before prescribing or dispensing any medication, dentists should review a patient’s current medications and existing medical conditions. They should review health history along with the patient to identify known allergies and to avoid contraindications. This review process and discussion should then be documented and included in the patient’s record. Dentists should not rely on patients to determine whether they are allergic to a drug or a derivative of a drug. Rather, they should refer to the Prescribers’ Digital References at pdr.net or consult with the patient’s treating physician to ensure appropriate medications are prescribed.

“The more time you take to research medication, the less likely you will be called upon to defend your prescribing decisions and protect yourself from allegations of negligence,” Solaiman said.

Clear guidelines on dispensing should be established and staff should be educated on these guidelines. Dentists should also use caution not to dispense or prescribe medications beyond their scope of practice and instead consult with the patient’s physician.

In addition, TDIC recommends adhering to the following health history guidelines:

• If a patient is not certain about his or her medications, ask the patient to bring all medications to the dental appointment. Document all medications, including dosage and associated health conditions.

• Ensure that the form is legible and writing is not crowding into the margins. Attach an additional form if necessary.

• If it has been two to three years since treatment, consider asking the patient to complete a new health history.

• Obtain a new health history on minor patients once they turn 18.

• Attach new forms to the old health history. Do not discard the previous health history.

• Every two years, check with your local dental society or professional liability carrier for any required changes to the form.

Although adverse reactions to medication and dental products can and do happen, there are preventative measures to take to limit their occurrence. The most effective way to keep patients safe is by keeping thorough health history forms and holding open, face-to-face conversations with patients. Doing so gives dental practitioners the information they need to make the right treatment decision based on individual need.