There are significant standard of care issues involved in dealing with a patient who is under the influence. Policies and procedures can help your dental practice prepare for this situation.

Posted in Risk Management on Tuesday, October 18, 2016

Recreational marijuana and alcohol use cross many cultures, ages, genders and socioeconomic statuses. As more states legalize marijuana, your dental practice needs to prepare for patients who show up under the influence of drugs or alcohol.

Should you treat patients who are under the influence?

While your first reaction to a patient who is under the influence may be shock, it is important to take a step back and examine the situation objectively.

There are significant standard of care issues involved in dealing with a patient under the influence. As a provider, you should make sure to follow the standards of care with regard to health/medicine histories, indications and contraindications.

Generally speaking, a patient whose condition is stable yet inebriated or otherwise impaired should be rescheduled. 

To help determine when rescheduling is appropriate, you should establish office policies and procedures for dealing with patients suspected of being under the influence.

Policies and procedures to consider for working with patients under the influence

• Be objective and avoid labeling the patient or scenario.
• Discuss the situation with the patient. Question if there is a history of dependency and if the patient would like to discuss or remedy the situation. 
• Obtain information on the substance taken, the amount and when it was ingested. Give consideration as to how accurate the patient’s responses might be.
• Question if the patient understands the impact that their actions and dependency could have on their health situation.
• Offer support materials and referral information.
• Recommend rescheduling the appointment.
  • Advise the patient that intoxication may limit your ability to accurately assess and treat them.
  • Advise the patient of the necessity of not indulging prior to a visit and the ramifications that drugs/alcohol could have on the success of treatment if they indulge after treatment is rendered.
• Safe transportation protocols may need to be initiated and your policies should define how this is determined. 
• Establish in-office safety protocols as potential behavior issues may arise (i.e. when to call the police and code words to alert staff of a possible problem).

Lastly, don’t forget to document all patient discussions thoroughly. Include patient comments (quotes are recommended) and any non-compliance, along with the advice, instructions and educational resources that you provided within the documentation.