Standards of Practice

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1.1 The purpose of these Standards of Practice is to set reasonable expectations of Dental Assistants in their professional practice. While specific treatments and procedures may vary based on a variety of circumstances, including patient need, materials, equipment and operator preference, the standards for professional practice do not change. Dental Assistants will use their knowledge, skills and judgments to meet patient needs, employing these Standards to ensure delivery of quality professional care. These Standards align with and are mutually supportive of the Code of Ethics. Dental Assistants are any regulated members of the College of Alberta Dental Assistants with a valid practice permit, including those on the General Register, the Provisional Register and those on the Courtesy Register.

2.1 Through the College of Alberta Dental Assistants (“College”), the Alberta government has granted the privilege of self-regulation to dental assisting in Alberta. This privilege requires Dental Assistants to meet standards for entry to practice and for continuing to practice. Dental Assistants are educated health care professionals who practice to the highest standards to ensure protection of the public. Dental Assistants understand the role of self regulation in ensuring the public interest takes precedence over professional or personal advocacy.

Criteria

2.2 Dental Assistants

a) understand and fulfill the requirements of the Health Professions Act and the Dental Assistants Profession Regulation and all other legislation that impacts the provision of oral health care services to Albertans;

b) demonstrate through their professional practice the key principles in the College Code of Ethics and these Standards of Practice;

c) practise within the standards, guidelines, policies and procedures of the College;

d) work within the policies and procedures of their place of practice;

e) understand and adapt to evolving health care systems and expectations of patients, the public, governments, employers and the dental industry;

f) undertake regular education and training initiatives to ensure they are current in knowledge and competent to practice;

g) promptly report harm or illegal practice of themselves and others to the appropriate regulatory college;

h) maintain the level of professional liability (malpractice) insurance required by the College Council; and,

i) report potential professional liability (malpractice) claims immediately to the insurance company.

3.1 Dental Assistants place patients’ well-being first.

Criteria

3.2 Dental Assistants

a) are guided by the patient’s needs;

b) continually evaluate processes and outcomes to meet and improve the standard of care for patients;

c) maintain complete and accurate patient records in compliance with the policies and protocols of their place of practice and all relevant legislation or professional regulatory requirements;

d) respect and maintain the confidentiality of patient-related information:1

e) advocate for patients to assist them in meeting their oral health care needs; and,

f) avoid real or perceived conflicts of interest.

1 Personal Information Protection Act, Health Information Act, etc.

4.1 A Patient is defined as an individual who is involved in or has had a professional interaction with a Dental Assistant.

An individual will be considered a Patient for one-year (365 days) after the last date of professional interaction between the individual and the Dental Assistant.

For the purposes of the sexual abuse and sexual misconduct provisions of the HPA, the following persons listed below will not be considered to be a patient:

  • a Dental Assistant’s spouse;
  • a Dental Assistant’s adult interdependent partner; or,
  • an individual who has a pre-existing on-going sexual relationship with the Dental Assistant prior to the date when the Dental Assistant first had a professional interaction with that individual.

The Patient/Dental Assistant relationship is terminated when professional interactions have ceased and:

  • 365 days have passed since the last professional interaction;
  • Neither the Dental Assistant nor the Patient have any expectation of ongoing care;
  • The Patient has moved their care to another dental office; or
  • The Dental Assistant has moved to a different dental office or professional setting.

4.2 Dental Assistants must establish and maintain appropriate boundaries with patients, and people with whom they have any form of personal or sexual relationship, to avoid real or perceived personal conflicts of interest or boundary issues.2

4.3 Dental Assistants will complete the mandatory education as approved by Council from time to time3 and incorporate the concepts into their practice to prevent “sexual abuse” and “sexual misconduct” as those terms are defined in the Health Professions Act.

Criteria

4.4 Dental Assistants

a) will not enter into an adult interdependent relationship or sexual relationship with a current patient;

b) must refrain from entering into an adult interdependent partner relationship or sexual relationship with a former patient until

(i) at least one-year (365 days) has passed since the last professional interaction occurred and the professional relationship has terminated; and,

(ii) there is minimal risk of a continuing power imbalance as a result of the professional Dental Assistant-patient relationship;4

c) may provide professional services to a spouse, adult interdependent partner or a person with whom there is a pre-existing on-going sexual relationship, however, if personal bias, a power imbalance or conflicts of interest5 arise when providing treatment, Dental Assistants must refer the individual to another regulated health care provider for any remaining treatment;

d) maintain a clear distinction between personal and patient relationships;

e) must maintain ethics, demonstrate respect for and sensitivity to personal boundaries, and clarify the roles and goals in the Dental Assistant-patient relationship;

f) recognize their unique position of power in professional care relationships;

g) decline special recognition from patients that may influence future treatment decisions such as gifts, money and social invitations; and,

h) make all treatment or care decisions in the patient’s best interest.

2 For more information about professional boundaries, refer to the CADA publication Therapeutic Relationships and Professional Boundaries: A Guide for Dental Assistants.
3 From time to time means that, although Council has approved the current education, the Council retains the right to approve new, revised and/or additional education, which would also be mandatory.
4 This standard continues to apply upon cancellation of registration or status change where the Dental Assistant is no longer a regulated member with a valid practice permit issued by the College of Alberta Dental Assistants.
5 Personal bias, a power imbalance or conflicts of interest can result in the Dental Assistant providing a different standard of care than their usual and customary practice in a similar circumstance treating a patient with whom they have no personal relationship.

5.1 Dental Assistants demonstrate through their professional practice the principles in the College Code of Ethics approved by the College Council.

Criteria

5.2 Dental Assistants

a) value the privilege of self-regulation;

b) demonstrate professional integrity;

c) demonstrate professional decorum such as using effective communication and appropriate use of social media; and,

d) promptly report unsafe practice and unprofessional conduct by health care workers to the appropriate authority.

6.1 Dental Assistants use appropriate communication strategies to ensure successful outcomes for patients, team members and others.

Criteria

6.2 Dental Assistants

a) obtain or assist in obtaining informed consent by providing complete information prior to commencing any treatment;

b) understand and accept the patient’s right to withdraw consent at any time;

c) are honest and truthful in their practice;

d) understand the requirements of the Health Information Act and the custodian’s6 policies and procedures for protecting patient’s personal and health information;

e) adhere to the custodian’s policies and procedures for collecting, storing, updating, disclosing and destroying patient information;

f) communicate respectfully with patients, team members and others;

g) respond to requests for information promptly and professionally; and,

h) treat others with respect, refraining from all types of discrimination, harassment or bullying behaviour including verbal, written, body language, social media and any other harmful type of communication with patients, colleagues and the public.

6 Health Information Act s.1(1)(f)(ix) “custodian” a health services provider who is designated in the regulations as a custodian, or who is within a class of health services providers that is designated in the regulations for the purpose of this subclause.

7.1 The College authorizes Dental Assistants to provide services to patients based on their formal education, training and examination. Regardless of direction or supervision, Dental Assistants are responsible and accountable for all services they provide.

Criteria

7.2 Dental Assistants

a) confine their practice to only those activities authorized to them by the Health Professions Act and the College;7

b) ensure they are competent to perform authorized services, seek assistance if unable to perform a service or refer patients to someone who is authorized and can provide the treatment safely and competently;

c) seek authorization for additional activities after pursuing formal education and/or training to expand their practice within the accepted practice of the dental assistant;

d) decline to perform any services not authorized to them by the Health Professions Act and the College; and,

e) promptly report unskilled and/or illegal practice to the appropriate authority.

7 Dental Assistants are authorized to provide services based on their formal education, training and examination.

8.1 The Dental Assistants Profession Regulation authorizes Dental Assistants to perform restricted activities including exposing radiographs, dental probing, preliminary fitting of complete or partial dentures, preliminary fitting of periodontal appliances, preliminary fitting of orthodontic appliances and scaling. Regardless of direction and supervision, Dental Assistants are responsible and accountable for all restricted activities they perform.

Criteria

8.2 Dental Assistants

a) must be authorized by the Health Professions Act and the College to perform restricted activities;

b) are granted authorization to perform restricted activities only after successfully completing required formal education and training;

c) when performing a restricted activity, require supervision by a dentist, dental hygienist or denturist authorized to perform the restricted activity. The supervising professional must be on site and available to assist; and,

d) must refuse to perform restricted activities not authorized to them by the Health Professions Act and the College.8

8 The College grants authorization for each skill based on formal education and training. Not all dental assistants are authorized to perform all restricted activities in the Dental Assistants Profession Regulation. Check the Dental Assistant Registry to confirm eligibility to perform specific activities including restricted activities.

9.1 Dental Assistants registered on the General Register may supervise students enrolled in a Council-approved dental assisting program and/or Dental Assistants on the Provisional Register. A Dental Assistant who is eligible to and consents to supervise is responsible to ensure the delivery of safe and appropriate care by the person(s) they are supervising. The supervising Dental Assistant will help the supervised person to reflect on their practice and evaluate outcomes to achieve current standard of care and best practices.

Criteria

9.2 Dental Assistants on the General Register

a) may supervise dental assisting students and Provisional Dental Assistants;

b) must consent to supervise;

c) must remain on site and be available to assist when supervising; and,

d) must be authorized to perform the supervised services.

9.3 Dental Assistants on the Provisional Register are not eligible to supervise dental assisting students or other Provisional Dental Assistants.

10.1 Dental Assistants meet all requirements set by the Health Professions Act, the Dental Assistants Profession Regulation and the Council for initial registration and annual practice permit renewal.

Criteria

10.2 Applicants for initial registration

a) must provide proof of meeting the requirements for registration set by legislation and by the Council; and,

b) must pay the fees established by Council.

10.3 Dental Assistants

a) must renew their practice permit annually; and,

b) meet the requirements set by Council for practice permit renewal including completing competence requirements and paying fees by the date specified in College policy and bylaws.9

9 CADA Bylaw 13.04 requires renewal payments to be received by October 31 each year; Competence requirements must be completed by November 30 each year.

11.1 Dental Assistants engage in continuing competence activities to enhance the provision of services to their patients and to remain current in knowledge and application of that knowledge. Competent means having the knowledge, skills, attitude and judgment to consistently achieve successful results and reduce the risk of harm to patients.

Criteria

11.2 Dental Assistants

a) annually meet the requirements of the continuing competence program established by Council;

b) ensure their competence activities relate to the role of dental assistants;

c) use the College Competency Profile and related self-assessment tool to proactively plan enhancements and growth to their dental assisting practice;

d) limit professional practice to services they are authorized and currently competent to perform and that are appropriate in the current circumstance;

e) meet or exceed the most recent Alberta Dental Association and College Infection Prevention and Control Standards and Risk Management for Dentistry, as approved by the College from time to time,10 and any other applicable guidelines or legislation necessary to meet the current standard of care;

f) understand the occupational health and safety rules that apply to their work setting;

g) participate in occupational health and safety activities as required in the Occupational Health and Safety Act, Regulation and Code to ensure their place of employment is safe for patients, colleagues and themselves; and,

h) assess the impact of their competence activities on their dental assisting practice and adjust as necessary to maintain and enhance competence.

10 From time to time means that although the College has approved the ADA&C document as the standard to which dental assistants must practice, the College retains the right to approve new, revised and/or additional IPC standards, which would also be enforceable.

12.1 Dental Assistants are responsible and accountable for their own practice and the decisions they make, regardless of direction or supervision. Dental assistants are responsible to know and comply with requirements of the College to remain in good standing.

Criteria

12.2 Dental Assistants

a) ensure their contact and employment information remains current in their College records;11

b) complete their competence requirements and provide proof by the end of each annual renewal deadline;12

c) respond and provide any information requested by the College in a timely manner;13

d) participate fully and meaningfully in inquiries, investigations and discipline proceedings by the College;14

e) critically consider all available information prior to providing services to patients;

f) make evidence-based decisions;

g) take responsibility for decisions and actions;

h) collaborate with the health care team and the patient to make informed decisions;

i) maintain accurate patient records;

j) meet the requirements of the Health Information Act and the custodian’s policies and procedures for managing personal and health information of patients; and,

k) evaluate their practice outcomes and adjust as necessary to ensure best practices.

11 Dental Assistants Profession Regulation s.31(1)
12 The registration term ends November 30th each year.
13 The College will normally ask for a response by a specific date.
14 Health Professions Act s.1(1)(pp)(vii)(B) and s. 63

13.1 Dental Assistants through their practice demonstrate appropriate skills, attitudes and judgment when applying their knowledge to meet the current standard of care.

Criteria

13.2 Dental Assistants

a) participate in learning and research activities to remain knowledgeable about the current standard of care;

b) collaborate with the health care team to promote excellence in care;

c) provide care that is appropriate to the diagnosis, circumstances and patient needs;

d) provide care that is evidence-based and meets the current standard of care; and,

e) provide only those treatments that are within their authorized practice and that meet the patient’s current needs and treatment plan.

14.1 Dental Assistants take responsibility to care for themselves to ensure they are able to provide the attention and treatment to patients required to ensure services in the best interest of patients.

Criteria

14.2 Dental Assistants

a) are aware of issues that may affect their ability to provide safe, competent care;

b) take steps to ensure patients receive appropriate care by another health care worker if the Dental Assistant is unable to provide that care themselves;

c) promptly remove themselves from practice if they cannot provide care safely and competently;

d) promptly report to the College if their ability to provide care has been compromised;

e) promptly report to the appropriate college if they are aware of health care workers whose ability to provide safe competent care has been compromised and the health care worker has not taken steps to ensure the health and wellbeing of patients; and,

f) promptly report to the College complaints director if they have reasonable grounds to believe the conduct of another regulated member of any college constitutes unprofessional conduct, sexual misconduct or sexual abuse.15

15 Subject to Health Professions Act s. 127.2(2)

15.1 In addition to reporting on their own fitness to practice, dental assistants are required in legislation to make other reports to the College.16

Criteria

15.2 Dental Assistants

a) who are regulated members of more than one profession, must report to the Registrar as soon as reasonably possible if another college has found them guilty of unprofessional conduct, and provide a copy of that decision to the Registrar;

b) who are/ were regulated members in a similar organization in another jurisdiction and are/ were found guilty of unprofessional conduct, must as soon as reasonably possible, report that decision and provide a copy of the decision to the Registrar;

c) must report any finding of professional negligence made against the Dental Assistant to the Registrar in writing as soon as reasonably possible after the finding is made; and,

d) must report in writing to the Registrar as soon as reasonably possible, if they have been charged with an offense under the Criminal Code (Canada) or have been convicted of an offense under the Criminal Code (Canada).

16 Health Professions Act s. 127.1

16.1 Dental Assistants must report to the appropriate authority when specific conditions or circumstances exist.

Criteria

16.2 Dental Assistants

a) report to the custodian when a breach of health information occurs;17

b) report to the Complaints Director if, in their professional capacity as a dental assistant, they have reasonable grounds to believe the conduct of another member of any regulated college constitutes sexual abuse or sexual misconduct;18

c) report to the local Child and Family Services if they have reasonable and probable grounds to believe a child is endangered and/or in need of intervention;19

d) report to the Medical Officer of Health if a patient under their care or supervision is infected with a notifiable communicable disease;20 and,

e) report to the Medical Officer of health if they know of or have reason to believe a nuisance or threat to public safety exists, such as pandemic.21

17 Health Information Regulation, s. 8.2(1)
18 Health Professions Act, s. 127.2(1)
19 Child, Youth and Family Enhancement Act, s. 4
20 Public Health Act, s. 22(1)
21 Health Professions Act, s. 1.1(1)

17.1 The Health Professions Act protects the titles Registered Dental Assistant and Dental Assistant and the initials RDA and DA. Only regulated members of the College can use these titles and initials.22

Criteria

17.2 Dental Assistants

a) on the Provisional Register with a current Provisional Practice Permit may use the title Dental Assistant and the initials DA;

b) on the General Register with a current Practice Permit may use the title Registered Dental Assistant and the initials RDA;

c) will not use a title, abbreviation, or initials protected in the Health Professions Act and Dental Assistants Profession Regulation to endorse or promote products or services or to promote an independent business venture of any kind; and,

d) must not use the protected titles unless they hold a current valid Practice Permit with the College.

22 Health Professions Act, s. 128(5) No person other than
(a) a regulated member shall use a title, abbreviation or initials set out in section 2 of a schedule to this Act alone or in combination with other words in a manner that states or implies that the person is a regulated member of the college to which section 2 of the schedule refers.
Health Professions Act, Schedule 4, s.2, A regulated member of the College of Alberta Dental Assistants may, as authorized by the regulations, use any of the following titles, abbreviations and initials:
(a) dental assistant;
(b) registered dental assistant;
(c) certified dental assistant;
(c.1) provisional dental assistant;
(d) DA
(e) RDA

For the purposes of this document:

Adult interdependent partner means a person is the adult interdependent partner of another person if:

a) the person has lived with the other person in a relationship of interdependence

(i) for a continuous period of not less than 3 years, or

(ii) of some permanence, if there is a child of the relationship by birth or adoption, or

b) the person has entered into an adult interdependent partner agreement with another person but does not include a former adult interdependent partner.i

Adult interdependent partner relationship means a relationship outside of marriage in which two people: share one another’s lives; are emotionally committed to one another; and, function as an economic and domestic unit. A person who is a spouse cannot be part of an adult interdependent relationship.i

Patient is defined as an individual who is involved in or has had a professional interaction with a Dental Assistant.

An individual will be considered a patient for one-year (365 days) after the last date of professional interaction between the individual and the Dental Assistant.

For the purposes of the sexual abuse and sexual misconduct provisions of the HPA, the following persons listed below will not be considered to be a patient:

  • a Dental Assistant’s spouse;
  • a Dental Assistant’s adult interdependent partner; or,
  • an individual who had a pre-existing on-going sexual relationship with the Dental Assistant prior to the date when the Dental Assistant first had a professional interaction with that individual.

Power imbalance In the Dental Assistant-patient relationship, the Dental Assistant holds the balance of power due to his/her position as a health care provider, specific dental-related knowledge and the patient’s dependence on the Dental Assistant to provide the care needed. Dental Assistants have access to personal information about the patient and have influence over the treatment provided adding to the imbalance.

Professional interaction The Dental Assistant participates in delivery of oral health care for a patient for the majority of the appointment. The service(s) the Dental Assistant provides or assists with would reasonably be expected to result in an entry to the patient record and/or billing for services to the patient or a third party on behalf of the patient.

Sexual abuse means the threatened, attempted or actual conduct of a regulated member towards a patient that is of a sexual nature and includes any of the following conduct:

a) sexual intercourse between a regulated member and a patient of that regulated member;

b) genital to genital, genital to anal, oral to genital, or oral to anal contact between a regulated member and a patient of that regulated member;

c) masturbation of a regulated member’s patient by that regulated member;

d) encouraging a regulated member’s patient to masturbate in the presence of that regulated member;

e) touching of a sexual nature of a patient’s genitals, anus, breasts or buttocks by a regulated member.

Note: A Dental Assistant found guilty of sexual abuse will have their registration and practice permit permanently cancelled. Other penalties in s. 82 of the Health Professions Act may also apply.

Sexual misconduct means any incident or repeated incidents of objectionable or unwelcome conduct, behaviour or remarks of a sexual nature by a regulated member towards a patient that the regulated member knows or ought reasonably to know will or would cause offence or humiliation to the patient or adversely affect the patient’s health and well-being but does not include sexual abuse.

Note: A Dental Assistant found guilty of sexual misconduct must have their practice permit suspended and may have their registration and practice permit cancelled at the discretion of the Hearing Tribunal. A Dental Assistant whose registration and practice permit is cancelled due to sexual misconduct may apply for reinstatement after 5 years. Other penalties in s. 82 of the Health Professions Act may also apply.

Sexual nature does not include any conduct, behaviour or remarks that are appropriate to the service provided.

Spouse means a person who is legally married to another.i

i Government of Alberta. (2002). Adult Interdependent Relationships Act. Available at: http://www.qp.alberta.ca/documents/Acts/A04P5.pdf

August 12, 2019

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