bleeding disorder or other serious medical condition) would significantly compromise the patient’s health, the patient may be referred for his or her dental treatment. Other referral situations may include: ● The behavior of the patient (e.g., a pediatric patient may be referred to a pedodontist to ensure proper treatment and avoid harm to the patient). ● The complexity of the treatment (e.g., multiple units of crown and bridge and/or implants). In summary, a referral is warranted in any circumstance in which the GP feels that a specialist will better serve the patient’s treatment (ADA, 2016). In response to the 2000 HMD report and the subsequent attention to medical/dental errors, the focus in health care has gone from blame to recognizing that errors can occur at any point in the healthcare delivery system. Making errors visible, studying their causes, and designing methods to improve the system represent a major shift in health care from individual blame to recognizing medical/dental errors as a way to improve the current system. The Institute for Healthcare Improvement (IHI, n.d.) defines a culture of safety as one in which “staff members are aware of safety issues and are free to report conditions that could lead to near misses or actual adverse events. This open exchange of information requires the management to have a non-punitive response philosophy that rewards reporting of safety issues and events and does not punish staff members involved in errors or adverse events related to system failures.” The National Patient Safety Foundation established the Lucian Leape Institute to provide strategic guidance for achieving safe health care (Leape et al., 2009). The institute describes a culture of safety as one that is “open, transparent, supportive, and committed to learning where doctors, dentists, nurses, and all health workers treat each other and their patients competently and with respect; where the patients’ interests are always paramount; and where patients and their families are fully engaged in their care” (p. 425). Leape and his associates (2009) maintain that safety does not depend on measurements, practices, and rules, but on achieving a culture of trust, reporting, transparency, and discipline – a culture of safety. Whereas errors define the boundaries of safe practice, the cultural focus must be on preventing blame. These principles must permeate every level of the organization (Morath, 2008). To achieve this vision, the Lucian Leape Institute states that healthcare systems must achieve five transforming concepts: 1. Transparency must be practiced at all times. 2. Care must be delivered by multidisciplinary teams working in integrated care platforms (chronic care, acute care, Identifying and analyzing medical/dental errors Improving patient safety involves recognition of errors, followed by the analysis of the root causes and contributing factors. Developing and implementing a plan to prevent or control future errors is also necessary to complete the process. Determining the actual rate of medical/dental errors is difficult because most estimates are based on self-reports. Self-report requires individuals to identify that an error has occurred, recognize that it is a reportable event, and not fear repercussions from reporting the event. These “incident” reports uncover only a small portion of actual medical/dental errors (Wachter, 2012). Identification of errors To improve the measurement of patient safety events in healthcare organizations, AHRQ (2005, 2006) developed a set of Patient Safety Indicators (PSIs) that can be used with hospital discharge data to screen for potential errors. The PSI set
Patients have filed malpractice charges against dentists claiming that the dentist discriminated against them based upon their religion, race, sex, nationality, and infectious disease status. When referring a patient, it is imperative that the dentist document the reason(s) for the referral and describe the patient consultation conversation regarding the referral in the dental record. The GP should coordinate the referral, follow up with the patient regarding the treatment outcome, and properly document these incidences of patient contact in the patient record.
A CULTURE OF SAFETY: IDENTIFYING, ANALYZING, AND REPORTING MEDICAL/DENTAL ERRORS Building a culture of safety
end-of-life care, etc.). In dentistry, comprehensive care would involve proper referral to specialists and physician consultations. 3. Patients must become full partners in all aspects of health care, including oral health. 4. Healthcare workers need to find joy and meaning in their work. 5. Health professionals’ education – including that of oral healthcare professionals – must be redesigned to prepare new care providers to function in the new environment (Leape et al., 2009). In a culture of safety, errors are viewed as opportunities to improve the system. As cultural changes do not occur quickly, the efforts on the part of all healthcare providers must be consistent and sustained (IHI, n.d.). Several strategies, such as safety reports at shift changes, appointing a safety champion for every unit, designating a patient safety officer with a position in administration, and conducting patient safety walk-arounds and safety briefings, are some approaches to building a culture of safety (IHI, n.d.). This strategy can be made applicable to a private dental practice by the appointment of a staff member as the safety coordinator to oversee patient safety issues and present current issues and reviews in patient safety relating to dentistry. Patient safety experts also believe that to be successful, all individuals at all levels (including patients) must contribute to a culture of safety (U.S. Department of Veterans Affairs, 2014a). One of the features of a culture of safety is the emphasis on full disclosure to patients after a medical error has occurred. Although this remains difficult, experts have stressed the need to apologize to patients and their families for errors (Leape, 2006). Full disclosure involves telling the patient and family what went wrong and explaining steps to prevent future errors (Straumanis, 2007). Although patient participation is key, it is important to remember that the responsibility to provide safe care rests with providers and healthcare organizations. includes 20 hospital-level indicators and 7 area-level indicators. The IHI developed a list of 53 “triggers” with a similar purpose – to identify potential adverse events that occurred during hospitalization (Griffin & Resar, 2009). Both of these tools are useful in determining whether a patient has suffered from an adverse event; however, these tools have limitations because they: ● Are retrospective, meaning that the event is not identified until after the patient has suffered harm. ● Require additional review to determine if there was a preventable adverse event. ● Will not identify all preventable adverse events. Root cause analysis Root cause analysis is a widely used structured method of identifying the causal and contributing factors underlying adverse events with the continuing goal of preventing
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