Table 2: State of Florida Code 15 Sentinel Events Report to Agency for Health Care Administration within 15 days of occurrence: ● The death of a patient. ● Brain or spinal damage to a patient. ● The performance of a surgical procedure on the wrong patient.
● The performance of a wrong-site surgical procedure. ● The performance of a wrong surgical procedure. ● The performance of a surgical procedure that is medically unnecessary or otherwise unrelated to the patient’s diagnosis or medical condition. ● The surgical repair of damage resulting to a patient from a planned surgical procedure, where the damage is not a recognized specific risk, as disclosed to the patient and documented through the informed consent process. ● The performance of procedures to remove unplanned foreign objects remaining from a surgical procedure. Note: From Florida Statute 395.0197. Retrieved from http://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&Search_ String=&URL=0300-0399/0395/Sections/0395.0197.html Cases of adverse events
In 2013, Mettes, Bruers, van der Sanden, and Wensing completed a systematic retrospective analytic review of electronic records for patient potential adverse events in the Netherlands. They analyzed 1000 records consisting of 50 patients from 20 practices, which amounted to 13,615 patient contacts over the 5-year period of analysis. The authors found that 18 adverse events had occurred; three were considered to be potential adverse events (or near misses), with the remaining 15 considered preventable. The adverse events included one wrong tooth extraction, four cases of remaining roots following tooth extractions, eight cases relating to endodontic therapy (including fractured instruments, perforations, and leakage of sodium hypochlorite into the apical tissues) and two cases of crowns being swallowed by patients. The three “near misses” were all in relation to radiographs not being taken prior to third molar extractions. Obadan and colleagues (2015) performed a retrospective review of dental adverse events reported in the literature. High-risk populations Although the safety of all patients is of primary concern to healthcare professionals, some patients presenting special concerns include: ● Infants and children. ● Older adults. ● Pregnant or breastfeeding patients. ● Patients in intensive care units. ● Persons of limited language skills or limited literacy. ● Patients with impaired renal function, liver function, or immune systems. It is important that healthcare providers recognize the special needs of vulnerable patients. Infants and children The most common anesthesia used in children’s dental care is local anesthesia. Complications from dental anesthesia for children are a major area of concern for practitioners. True anesthetic allergies are rare, but complications are common. Diligent monitoring of the child and staff training in advanced life support techniques are essential for successful anesthesia use in children. With proper airway management and ventilation, an anesthetic-induced seizure resulting from a local anesthetic overdose often ceases in less than one minute (Malamed, 2003). Dental practitioners must carefully review a patient’s health status and other conditions that may cause adverse effects. An adverse drug reaction is most likely to occur during the injection or within 5 to 10 minutes (American Academy of Pediatric Dentistry, 2009). Calculate the local anesthetic dose for each patient, based primarily upon his or her weight (mg drug/kg body weight) and physical status (Weaver, 2007). Base dosage on ideal body weight rather than actual weight for patients who are obese. Young children with low body weight are at higher
Databases were searched and data were extracted on background characteristics, incident description, case characteristics, clinic setting where the adverse event originated, phase of patient care when the adverse event was detected, proximal cause, type of patient harm, degree of harm, and recovery actions. The review identified approximately 182 publications (270 cases). Delayed and unnecessary treatment/disease progression after misdiagnosis was the largest type of harm reported. Of the reviewed cases, 24.4% reported permanent harm to the patients; death of the affected patient was reported in one of every ten adverse event case reports reviewed. These case reports provided a window into understanding the nature and extent of dental adverse events, but for as much as the findings revealed about adverse events, they also identified the need for more broad- based contributions to the collective body of knowledge about adverse events in the dental office and their causes.
HIGH-RISK POPULATIONS AND PATIENT EDUCATION
risk for receiving relatively large amounts of local anesthetic (Chin, Yagiela, Quinn, Henderson, & Duperon, 2003). Toxic levels of local anesthetic are reached quickly in children. Overdose of local anesthetic can occur if blood pressure elevates and affects the central nervous system. The child can become unconscious or experience complete respiratory failure. Local anesthetic toxicity is exceptionally rare in infants and children; however, dysrhythmias, cardiovascular collapse, seizures, and transient neuropathic symptoms have been reported (Ecoffey, 2005). True allergies to local anesthetics occur in fewer than 1% of cases (Bahl, 2004). The bones in a child’s head and neck are less dense than are those in adults, increasing the risk with local anesthesia, which will be absorbed and dispersed more quickly. Both local effects and systemic effects can be seen in complications of local anesthetic administration (Chiu, Lin, Hsia, Lai, & Wong, 2004). Local effects may include but are not limited to spread of infection, hematoma, nerve damage, or blocking of the facial nerve. Infections, risk of bacterial heart infection, cardiovascular problems, liver disease, and other complications can be seen in systemic effects (Chin et al., 2003). Success of dental anesthesia procedures depends on proper monitoring of the patient and giving clear, concise postoperative instructions to the parents or guardians. Because children’s dosages are dependent upon age, weight, and other factors, dental practitioners should create a chart showing the maximum number of carpules of various local anesthetics to be used for various body weights. Charts should be posted in every operatory of the dental office. Remaining current in specialized training and continuing education is also extremely important to the success of the dental practice and the health of its patients (Malamed, 2003).
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