Introduction
Purpose
This procedure establishes the required response when a patient swallows or may have aspirated a foreign object during dental treatment. Foreign objects may include rubber dam clamps, burs, crowns, implant components, broken instrument fragments, debris, or other treatment related materials.
Scope
This procedure applies to ASOD faculty, staff, residents, learners, and other authorized health care providers involved in patient care. It applies to patients receiving treatment in ASOD clinical locations.
Relationship to Medical Emergency Requirements
A swallowed or aspirated foreign object may become a medical emergency. Personnel must follow the ASOD Management of Medical Emergencies Policy when the patient demonstrates respiratory distress, altered consciousness, significant clinical deterioration, or another condition requiring immediate intervention.
Personnel must activate the ASOD Medical Emergency Team during regular hours by dialing 7-3911 from a ASOD landline. Outside regular hours, or when emergency medical services are otherwise required, personnel must call 911. Regular hours are Monday through Friday, 8:00 a.m. through 5:00 p.m., excluding University holidays and other periods when normal ASOD operations are closed
Immediate Response
Treating provider must stop treatment, remain with the patient, secure the treatment area, and account for the missing object when possible. Provider must assess the patient, monitor vital signs, evaluate for respiratory distress, and obtain relevant information regarding the event and the patient’s symptoms.
Provider must determine whether the patient is experiencing an emergency or is stable enough to proceed through the non emergency evaluation process. Incident Reporting and documentation must not delay emergency care.
Signs of a Potential Emergency
Personnel must activate emergency response immediately when the patient demonstrates difficulty breathing, choking, persistent coughing, wheezing, cyanosis, altered consciousness, significant chest pain, rapid deterioration, or another condition requiring immediate medical intervention.
Provider must deliver care within the limits of their training, obtain appropriate emergency equipment, and remain with the patient until the ASOD Medical Emergency Team or emergency medical services accepts responsibility.
Stable Patient
provider must explain the concern and need for radiographic evaluation when the patient is stable, alert, and not demonstrating respiratory distress. Radiographic evaluation is used to determine whether the object was ingested or aspirated. Patient must remain under observation until the evaluation and appropriate disposition are completed.
Incident Reporting
Provider or designated ASOD appointee must submit an incident report through the ASOD Incident Reporting App. Report must be submitted as soon as immediate patient needs permit and no later than 24 hours after the incident. Submission generates incident specific instructions and may provide required forms, maps, notifications, and follow up guidance. Treating provider retains responsibility for clinical management. Assignment of reporting, escort, or administrative duties to another individual does not transfer the provider’s clinical responsibility.
Non-Emergency Evaluation During Regular Hours
ASOD Radiology Review
Provider or designated appointee must escort the patient to ASOD Radiology on the first floor of Tarrson Hall and advise reception that the visit concerns a swallowed or potentially aspirated foreign object. ASOD Radiology personnel will assist with the preliminary imaging process and applicable radiology documentation. Provider must communicate relevant clinical information, including the type and approximate size of the object, the circumstances of the event, the patient’s symptoms, and the suspected time of ingestion or aspiration.
Medical Record Number
Patient must have a UNC Health Medical Record Number before receiving hospital radiology services. When the patient does not have an MRN, the provider or appointee must call (984) 974-2041, option 1, explain that urgent radiographic evaluation is required, and request assistance obtaining the MRN. The MRN must be recorded on the applicable Radiology Order Form and retained for documentation and follow-up.
Hospital Radiology Escort
Provider or designated appointee must escort the patient to the designated UNC Radiology location with the completed Radiology Order Form. Location map and related instructions are provided through the Incident Reporting App and associated email.
Attending provider or designated appointee is responsible for accompanying the patient. A wheelchair must be used when indicated by the patient’s condition, sedation status, fall risk, or ability to ambulate safely. Available wheelchairs may be obtained from the main Tarrson patient entrance or from ASOD Oral Maxillofacial Surgery. Transportation of a sedated patient requires additional caution. Provider must consider the patient’s level of sedation, monitoring needs, escort requirements, and risk of deterioration before transport.
Monitoring During Escort
Escorting provider or appointee must monitor the patient for respiratory distress or other changes in condition during transit. Emergency medical services must be activated immediately if the patient develops emergency symptoms. Escorting individual must remain with the patient until emergency responders arrive or until care is transferred to the receiving health care team.
Hospital Radiology Intake
Provider or appointee must explain that the patient is being evaluated for a swallowed or potentially aspirated dental object, provide the completed Radiology Order Form, and communicate the patient’s MRN and relevant clinical information. Applicable ASOD billing instructions must be provided to the receiving area. Provider or appointee must remain with the patient until imaging is completed or responsibility is transferred to the receiving health care team.
Imaging Results and Patient Disposition
Responsible provider must review available imaging findings with the radiology or receiving clinical team and determine the appropriate disposition.
Ingested Object
When imaging indicates that the object was ingested and no emergency condition is identified, the provider must explain the findings to the patient and advise the patient to contact their primary care or other appropriate medical provider for follow up. Follow up instructions may include monitoring symptoms, additional imaging, or other evaluation as directed by the medical provider. ASOD personnel must not provide medical assurances outside their training or authority regarding passage of the object or the need for further treatment.
Aspirated Object
When imaging indicates that the object was aspirated, the provider must ensure the patient receives immediate medical evaluation. Patient must be escorted or transferred to the emergency department unless the ASOD Medical Emergency Team, emergency medical services, or receiving provider directs otherwise
Provider must communicate the circumstances of the event, imaging findings, patient symptoms, and care already provided. Provider may leave after the receiving medical professional accepts responsibility and continued care has been appropriately arranged.
Unclear or Concerning Findings
When imaging is inconclusive, the patient develops symptoms, or the provider remains concerned about the patient’s condition, the provider must obtain further medical evaluation. Emergency medical services or the emergency department must be used when clinically indicated.
Response Outside Regular Hours
When a stable patient requires evaluation outside regular hours, the provider must follow the instructions generated through the Incident Reporting App and escort the patient to the designated emergency or after hours location. If a patient demonstrates emergency symptoms, personnel must call 911 and follow the emergency activation and transfer requirements in the ASOD Management of Medical Emergencies Policy.
Provider or appointee must remain with the patient, monitor for respiratory distress or clinical deterioration, provide relevant information to the receiving team, and remain until care is transferred or the receiving provider authorizes departure. Provider must document the patient’s disposition and all follow-up instructions.
Personnel must call 911 when the patient demonstrates emergency symptoms and follow the emergency activation and transfer requirements established by the ASOD Management of Medical Emergencies Policy.
Patient Refusal
A patient with decision-making capacity may refuse recommended radiographs or medical evaluation. Responsible provider must explain the purpose of the evaluation, the concern for ingestion or aspiration, the potential risks of declining evaluation, available alternatives, and symptoms requiring immediate emergency care.
Provider must document the discussion, the patient’s stated decision, and any instructions provided in the patient’s health record. Patient must complete the applicable Informed Refusal Form. Completed form must be uploaded to the corresponding incident report through the Incident Reporting App. Email should be used only when the document cannot be uploaded through the approved process or when directed by ASOD Clinical Compliance. Patient refusal does not eliminate the provider’s responsibility to activate emergency response when the patient lacks decision making capacity or has an emergency condition requiring immediate intervention.
Documentation
Responsible provider must document the event in the patient’s health record no later than 24 hours after the incident. Documentation must include, as applicable:
- The object involved and how the event occurred;
- The patient’s symptoms, clinical presentation, and vital signs;
- Immediate actions and treatment provided;
- The recommendation for radiographic or medical evaluation;
- The location and results of imaging;
- Whether the object was ingested, aspirated, or not located;
- Instructions provided to the patient;
- Referral or transfer to the emergency department or another provider;
- Patient refusal, when applicable;
- The patient’s disposition; and
- Preventive measures implemented or recommended to reduce recurrence.
Incident Report
ASOD incident report must contain an objective summary of the event, immediate response, patient evaluation, disposition, and known follow up. Supporting records must be uploaded when available and may include the Medical Emergency Response Record, Radiology Order Form, Informed Refusal Form, relevant non-clinical documentation, and supplemental information requested during incident review. Protected health information must be submitted only through approved systems and limited to information necessary for patient care, reporting, and review.
Follow-Up Documentation
Responsible provider must add supplemental information to the incident report when significant findings or outcomes become available after the initial submission. Supplemental information may include final imaging findings, emergency department disposition, updated patient instructions, or corrective measures implemented by the clinical area.
Billing and Patient Questions
Provider or appointee must communicate applicable billing instructions to the receiving radiology or health care location according to current ASOD processes. Patients who receive a bill or have questions about charges associated with the incident must be directed to ASOD Clinical Compliance. Providers must not promise or represent that ASOD will pay all associated charges.
Related Requirements
Unit Policies, Standards, and Procedures
Contact Information