We consider drugs and equipment for a medical emergency when we review if a practice is safe.
This relates to:
Medicines and equipment should be in an accessible and central location known to everyone.
Mandatory requirements
The General Dental Council standards for the dental team state that, as a dental professional, you must follow the guidance on medical emergencies and training updates issued by Resuscitation Council UK.
We expect a practice to follow the national guidance issued by Resuscitation Council UK. Immediate access to an automated external defibrillator (AED) in an emergency increases the chances of survival of the patient.
Where an AED is not available, we expect to see a robust and realistic risk assessment detailing how an AED could be accessed in a timely manner. Emergency services may not always be able to respond in the critical first few minutes of an acute cardiac arrest.
Recommended practice
Practices should ensure they have emergency medicines and equipment to keep patients safe.
Professional guidelines: NICE: Prescribing in dental practice (Medical emergencies in dental practice)
- These should be available to manage common medical emergencies:
- adrenaline/epinephrine injection, adrenaline 1 in 1000, (adrenaline 1 mg/mL as acid tartrate), 1 mL amps
- aspirin dispersible tablets 300 mg
- glucagon injection, glucagon (as hydrochloride), 1 - unit vial (with solvent)
- glucose (for administration by mouth)
- glyceryl trinitrate spray
- midazolam oromucosal solution
- medical oxygen
- salbutamol aerosol inhalation, salbutamol 100 micrograms/metered inhalation.
- This is the minimum equipment recommended:
- adhesive defibrillator pads
- automated external defibrillator (AED)
- clear face masks for self-inflating bag (sizes 0, 1, 2, 3, 4)
- oropharyngeal airways (sizes 0, 1, 2, 3, 4)
- medical oxygen cylinder
- oxygen masks with reservoir
- oxygen tubing
- pocket mask with oxygen port
- portable suction, for example Yankauer
- protective equipment – gloves, aprons, eye protection
- razor
- scissors
- self-inflating bag with reservoir (adult)
- self-inflating bag with reservoir (child)
- if there are ampules in the medical emergency drugs kit, there must be adequate numbers of suitable needles and syringes.
- Oxygen cylinders should be easily portable but must allow adequate flow rate (for example, 15 L min) for 30 minutes or until the arrival of emergency services. Local policy should dictate the precise size of cylinder and whether a second cylinder is needed in case the first one is at risk of running out.
- Quality Assurance Process: At least every week, check:
- expiry dates for emergency medicines
- equipment and availability of oxygen.
The manufacturer’s instructions must be followed about the use, storage, servicing and expiry of equipment. A planned replacement programme should be in place for disposable equipment items that have been used or that reach their expiry date.
Storing the glucagon injection
Glucagon is a hormone that helps to raise blood glucose levels. A glucagon injection kit is used to treat episodes of severe hypoglycemia, where a patient is either unable to treat themselves or treatment by mouth has not been successful.
Severe hypoglycemia is defined as having low blood glucose levels that requires assistance from another person to treat. Classed as a diabetic emergency, it is a complication that can occur in people with diabetes who take insulin and certain antidiabetic tablets.
The most commonly available form of Glucagon injection is the GlucaGen HypoKit 1 mg (Glucagon Injection).
Mandatory requirements
- GlucaGen HypoKit should be stored at a temperature of 2 – 8°C (in a refrigerator), but it must not be frozen. If stored in the refrigerator, the shelf life from the manufacturer should be followed.
- GlucaGen HypoKit can be stored outside the refrigerator at a temperature not exceeding 25°C for 18 months provided that the expiry date is not exceeded. It should be stored in the original package in order to protect from light. This is common practice as it needs to be easily accessible for emergency use. The provider must able to demonstrate either:
- when the product was out of refrigerated storage, for example, label the product with the date it was taken out of the fridge or a revised expiry date, or
- how the product is safe for use, for example, by referring to the purchase invoice showing that 18 months has not elapsed from delivery.