Emergency Medicines in Dental Practices: What Does CQC Expect?
Updated: 5 days ago
Medical emergencies are relatively uncommon in dental practices, but every practice must be prepared to respond safely when they occur. A patient may develop anaphylaxis, experience an asthma attack, become hypoglycaemic or suffer a cardiac event with little warning.
Having an emergency medicines kit is only one part of being prepared. Dental providers must ensure that the correct medicines are available, in date, stored appropriately and accessible without delay. Staff must also understand where the medicines are kept and be trained to recognise and manage medical emergencies.
The Care Quality Commission’s expectations are explained in Dental Mythbuster 4: Drugs and equipment for a medical emergency. This directs dental practices to the current British National Formulary and Resuscitation Council UK guidance.
This article explains the main requirements and some of the common weaknesses dental practices should avoid.
Which emergency medicines should a dental practice have?
The British National Formulary guidance on prescribing in dental practice identifies the medicines that should be available to manage common medical emergencies in dental settings.
The emergency medicines normally required are:
Emergency medicine | Principal emergency use |
Adrenaline injection 1:1,000, equivalent to 1 mg/ml | Anaphylaxis |
Aspirin 300 mg dispersible tablets | Suspected myocardial infarction, when clinically appropriate |
Glucagon 1 mg injection | Severe hypoglycaemia when oral glucose cannot be given or has not been effective |
Glyceryl trinitrate spray, 400 micrograms per metered dose | Angina or suspected acute coronary syndrome |
Midazolam oromucosal solution | Prolonged or repeated convulsive seizures |
Medical oxygen | Medical emergencies requiring supplemental oxygen, including cardiorespiratory arrest |
Salbutamol inhaler, 100 micrograms per actuation | Acute asthma or bronchospasm |
Oral glucose | Hypoglycaemia in a conscious patient who can swallow safely |
Dental practices should check the exact medicine, formulation, strength and presentation against the current BNF rather than relying indefinitely on a supplier’s pre-assembled emergency kit.
Guidance changes, products are discontinued and kit contents can vary. Purchasing a labelled “CQC-compliant” emergency kit does not remove the provider’s responsibility to confirm that it meets current national guidance.
Should dental practices keep medicines for children?
Practices treating children must consider paediatric emergencies as part of their risk assessment. Staff should understand that the correct dose of some emergency medicines depends on the child’s age or weight.
The practice should have immediate access to current age-specific guidance, including the BNF for Children where appropriate. Staff must also be trained in paediatric basic life support and familiar with any child-specific equipment provided.
The Resuscitation Council UK Primary Dental Care Quality Standards state that dental professionals who work with children should understand the differences between adult and paediatric CPR and practise using paediatric manikins.
A practice that routinely treats children should also consider whether its AED has paediatric pads or a paediatric mode. If these are provided, they must be checked alongside the adult pads and other emergency equipment.
Emergency medicines must be immediately accessible
Emergency medicines should be located where staff can retrieve them quickly. They should not be stored in a location that becomes inaccessible during part of the working day or behind several layers of locked storage.
This does not mean medicines should be left where patients or members of the public can access them. The practice must balance security with immediate clinical availability. A clearly labelled, tamper-evident container in a known location is generally more suitable than medicines being distributed across several cupboards.
Every member of staff should know:
where the emergency medicines are kept;
how to summon help;
who will bring the medicines and equipment;
who will telephone 999;
how emergency services will enter the premises;
who will meet and direct the ambulance crew; and
what information should accompany the patient if they are transferred to hospital.
These arrangements should be tested through realistic team-based scenarios rather than existing only within a policy.
How often should emergency medicines be checked?
CQC guidance and the Resuscitation Council UK standards indicate that emergency medicines and equipment should be checked at least weekly.
A named person should normally complete the check, with suitable cover arranged when that person is absent. The check should be documented so the practice can demonstrate that it has an effective and reliable system.
A weekly check should confirm:
all required medicines are present;
the correct strengths and formulations are available;
packaging is intact;
tamper-evident seals remain intact;
medicines have not expired;
stock used previously has been replaced;
medicines have been stored within the required temperature range;
the glucagon storage date remains valid;
sufficient oxygen is available;
the oxygen cylinder and flow controls are operational;
needles and syringes are available where injectable medicines are supplied;
AED pads and batteries are within date; and
relevant equipment is complete and functioning.
The person carrying out the check should record any problem and the action taken. Simply recording that a check occurred is not enough if an expired or missing item remains unresolved.
The Resuscitation Council UK equipment list for primary dental care also recommends auditing the checking system. This helps the provider confirm that weekly checks are being completed reliably and that identified problems are corrected.
How should glucagon be stored?
Glucagon is one of the most frequently misunderstood medicines in the dental emergency kit.
GlucaGen HypoKit should normally be stored in a refrigerator at between 2°C and 8°C and must not be frozen. However, the manufacturer permits it to be stored outside the refrigerator at a temperature not exceeding 25°C for up to 18 months, provided the manufacturer’s expiry date is not exceeded.
When glucagon is removed from refrigerated storage, the practice should record the date it was removed or calculate and clearly record the revised expiry date. It should remain in its original packaging to protect it from light.
The practice must be able to demonstrate that the product remains safe to use. Leaving the kit at room temperature without documenting when it left the refrigerator makes this difficult.
CQC previously covered this in a separate mythbuster, but that page has now been withdrawn because the information has been incorporated into Dental Mythbuster 4.
What are the requirements for medical oxygen?
Medical oxygen must be immediately available in all clinical dental areas. The cylinder must be portable but large enough to provide an adequate flow until the ambulance arrives or the patient recovers.
Resuscitation Council UK gives the example of a full CD-size cylinder, which contains approximately 460 litres and can deliver oxygen at 15 litres per minute for around 30 minutes. The precise cylinder size and whether a second cylinder is required should be determined through the practice’s local risk assessment.
Practices should check:
the amount of oxygen remaining;
the cylinder’s expiry or test date;
the integral valve and flowmeter;
the availability of suitable masks and tubing;
that staff know how to operate the cylinder;
that the cylinder is stored safely and securely; and
that the cylinder can be taken rapidly to any clinical area.
A cylinder being present does not provide assurance if it is nearly empty, staff cannot operate it or the correct mask and tubing cannot be found.
What equipment should accompany the medicines?
Emergency medicines cannot be considered separately from the equipment needed to administer them safely.
The Resuscitation Council UK minimum equipment list for primary dental care includes:
a portable oxygen cylinder;
oxygen masks with reservoirs and oxygen tubing;
a pocket mask with an oxygen port;
adult and child self-inflating bags with reservoirs;
appropriately sized clear face masks;
oropharyngeal airways in sizes 0 to 4;
portable suction, such as a Yankauer device;
an automated external defibrillator;
adhesive defibrillator pads, including a spare set;
a razor and scissors; and
appropriate personal protective equipment.
Where injectable medicines are supplied in ampoules, the practice must also have suitable sterile needles and syringes. A large-volume spacer should be available for administering salbutamol.
A blood glucose meter is also a valuable addition because symptoms such as confusion, sweating, aggression, drowsiness and collapse can have several possible causes. If the practice provides a meter, it must be maintained properly, used by trained staff and supplied with compatible test strips that are within date.
Does midazolam need additional controls?
Midazolam is a controlled drug. Dental providers should ensure its ordering, storage, access, administration and disposal comply with the applicable controlled drugs legislation and the practice’s medicines management procedures.
Its status as an emergency medicine does not remove the need for appropriate governance. At the same time, storage arrangements must not create a dangerous delay during a prolonged convulsive seizure.
The practice should obtain current pharmaceutical or controlled drug advice when determining its arrangements and ensure that staff understand who may administer the medicine and under what legal authority.
Emergency medicines training for the dental team
Having a complete emergency kit is of limited value if staff cannot recognise an emergency or are not confident using its contents.
Resuscitation Council UK states that dental professionals and other dental healthcare staff should update their resuscitation knowledge and skills at least annually. New staff should receive resuscitation training as part of their induction.
Training should cover more than CPR. It should include:
recognising deterioration;
using the ABCDE assessment;
anaphylaxis;
asthma;
hypoglycaemia;
angina and suspected myocardial infarction;
seizures;
syncope;
choking;
cardiorespiratory arrest;
calling 999 and communicating with ambulance control;
using medical oxygen;
operating the AED; and
staff roles during an emergency.
Hands-on simulation is particularly important for clinical staff. Practices should run regular scenarios in the actual working environment so that practical obstacles can be identified.
For example, a simulation may reveal that the emergency kit cannot be carried easily, the oxygen cylinder is unfamiliar, the AED is difficult to locate or staff are unclear who should meet the ambulance.
Recording and learning from a medical emergency
Following a medical emergency, the practice should document:
the patient’s symptoms and clinical condition;
relevant observations;
when the emergency began;
when 999 was called;
medicines administered, including dose, route and time;
oxygen administration;
use of the AED or other equipment;
the patient’s response;
advice received from ambulance control;
the time emergency services arrived; and
the patient’s transfer or clinical outcome.
The incident should then be reviewed through the practice’s incident reporting process. A team debrief should examine what went well, whether there were delays, whether medicines and equipment were easy to use and whether changes are required.
Any medicines or disposable equipment used must be replaced promptly. Where an incident identifies a wider safety concern, the provider should record an action, assign responsibility and confirm that the improvement has been completed.
Common CQC compliance problems
Common weaknesses include:
expired emergency medicines;
missing medicines or incorrect formulations;
undocumented weekly checks;
an oxygen cylinder with insufficient contents;
expired AED pads;
no spare AED pads;
glucagon stored outside a refrigerator without a revised expiry date;
injectable medicines without appropriate needles and syringes;
staff being unable to locate or operate the equipment;
incomplete paediatric arrangements;
training that has not been updated annually; and
actions from emergency simulations not being completed.
These problems usually indicate a weakness in governance rather than a single isolated oversight. A robust system should identify expiring stock in advance, allocate responsibility and provide assurance that corrective action has been completed.
A practical emergency medicines checklist
Dental providers should be able to answer yes to the following questions:
Does our emergency kit match the current BNF guidance?
Have we considered adults and children within our risk assessment?
Are the medicines and equipment immediately accessible?
Do all staff know where they are located?
Are checks completed and documented at least weekly?
Are expiry dates monitored far enough in advance to arrange replacement stock?
Is glucagon stored correctly with a documented revised expiry date where necessary?
Is sufficient medical oxygen available?
Can relevant staff operate the oxygen cylinder and AED?
Have all staff completed appropriate annual training?
Do we run practical emergency scenarios?
Are incidents, simulations and identified deficiencies followed by documented action?
Preparing your dental practice for CQC
CQC compliance requires more than purchasing an emergency medicines kit. Providers need a reliable system covering stock selection, storage, accessibility, weekly checks, staff competence, scenario training, incident reporting and audit.
Practices should periodically compare their arrangements with the latest CQC Dental Mythbuster 4, BNF dental guidanceand Resuscitation Council UK standards.
Need hands-on support for your dental practice? See my CQC support for dental practices.
As a former CQC inspector with extensive experience in dental regulation and practice management, I can help dental practices assess their emergency preparedness and identify gaps before they become inspection findings.
Find out more about my CQC compliance support or contact me to arrange a dental compliance review. Related reading: dental mock inspection, Blank Prescription Form Security in Dental Practices: A CQC Compliance Guide, How to Write a Governance Policy for a Dental Practice: A CQC Guide.
This article provides general compliance information and is not a substitute for current clinical guidance, professional training or patient-specific clinical judgement. Medicine selection, doses and administration protocols should always be checked against the current BNF, BNFC and Resuscitation Council UK guidance.
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