Leapfrog Group The Leapfrog Group, a healthcare arm of many of America’s largest employers, was created in part to promote patient safety activities. In 2001, the Leapfrog Group recommended three safe practices: computerized prescriber order entry, intensive care unit physician staffing, and evidence-based hospital referral (Leapfrog Group, 2010). The organization Updated dental safety issues A 2011 article by Perea-Perez, Santiago-Saez, Garcia-Marin, Labajo-Gonzalez, and Villa-Vigil suggests seven steps for improving patient safety, by ensuring that risk management is applied to clinical dentistry. These are summarized in Table 5. The steps are similar to those suggested by Shekelle and colleagues in the Annals of Internal Medicine in 2013; this paper describes the patient safety strategies that are ready for adoption based on best available evidence and also
maintains that adopting these three practices in all urban hospitals in the United States would save more than 57,000 lives, prevent 3 million serious medication errors, and save $12 billion each year. There is some evidence that the Leapfrog Group’s activities have led to more widespread adoption of the endorsed practices (Wachter, 2012). recommends priority areas of research to be pursued in order to answer outstanding questions on how to improve safety, including assessment of the impact of interventions designed to improve safety. They are also similar to the steps advised by the National Patient Safety Agency in the UK. These include the following: promote incident reporting, involve patients in the development of interventions, and implement solutions known to prevent harm (NPSA, 2009).
Table 5: Seven Steps to Improve Patient Safety in Dentistry 1. Promotion of a culture of patient safety in dental care. 2. Creating an organizational structure for the management of dental care risks. 3. Developing tools for the identification, analysis, and assessment of risks related with dental care. 4. Establishing lines of information on adverse events. 5. Establishing measures to prevent health care risks by elimination or reduction. 6. Ongoing training of professionals on patient safety. 7. Research in the field of dental patient safety. Note . Adapted from Perea-Perez, B., Santiago-Saez, A., Garcia-Marin, F., Labajo-Gonzalez, E., & Villa-Vigil, A. (2011). Patient safety in dentistry: Dental care risk management plan. Medicina Oral Patologia Oral Y Cirugia Bucal, 16 (6), e805-e809. Performance standards
In addition to international and national efforts to ensure safe health care, performance standards for healthcare personnel are controlled at the state level by licensing, accreditation, and certification processes. Performance standards protect public safety by assuring a level of competency. Licensing is the process by which an agency or government grants permission to a healthcare professional to engage in a given occupation after finding that the applicant has attained the degree of competency necessary to ensure that public health, safety, and welfare are reasonably well protected. Accreditation is the process whereby a professional organization or nongovernmental agency grants recognition to a school for health professionals, or a healthcare institution, for demonstrated ability to meet predetermined criteria. State licensing requirements for healthcare organizations vary widely. Each state sets its own standards, measurement, and enforcement. In many states, licensing and accreditation are intertwined (Kohn et al., 2000). The Joint Commission is the largest accrediting agency, accrediting and certifying more than 20,500 healthcare organizations and programs in the United States (TJC, 2017a). Standards for health professionals demonstrate more variability than those for healthcare organizations. Professional licensure is structured for each regulated profession within each state. Within states, there is little dissemination of information among different boards. Across states, there is variation in what is considered a complaint and in the disciplinary action taken (Benner, Malloch, & Sheets, 2010). Another issue related to professional licensure is the continued assessment of knowledge and skills. Although several states require ongoing education for health professionals, monitoring adherence to these requirements is spotty (HMD, 2009). The HMD has called for a more comprehensive educational system for the continued development of all healthcare professionals. The Florida Board of Dentistry requires that dentists complete a minimum of 30 continuing education hours every 2 years for license renewal. Hygienists must complete a minimum
of 24 hours every 2 years. Two hours of study in prevention of medical/dental errors and 2 hours of study in domestic violence (to be completed every third biennium in addition to the required 24 hours of continuing education) are mandatory. In addition to the required courses, dentists and hygienists must complete basic life support CPR training, including 1- and 2-rescuer CPR for adults, children, and infants. This course should be from the American Heart Association, American Red Cross, or an organization with similar requirements, and must include the use of automatic external defibrillators (AEDs) and Ambu bags (self-reinflating resuscitator bags). The additional course hours may include basic medical and scientific subjects, including but not limited to pharmacology, biology, physiology, pathology, and biochemistry. Programs on clinical and technical subjects – including but not limited to clinical techniques and procedures, materials, and equipment – are acceptable. Oral health and safety courses may be included, and other topics such as practice management (3 hours) – including substance abuse, effective communication, and time management – are acceptable. All courses must be administered through an accredited organization such as the ADA; state, district, and local dental societies; dental schools and colleges; and other organizations approved by the Florida Board. Most states have similar requirements as a measure to increase patient safety. Professional societies also contribute to patient safety in a variety of ways. Through annual conferences, professional groups develop practice guidelines and policy statements and communicate them to their memberships. Professional societies set and maintain certification standards. Certification is a process by which an individual, an institution, or an educational program is evaluated and recognized for meeting certain predetermined standards ( Mosby’s Medical Dictionary, 2008). Certification usually recognizes advanced achievement in a subspecialty within the profession, providing the public with additional information regarding the competency level of healthcare professionals.
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