● Some states permit the use of abbreviations in the dental record; some do not. In the state of Florida, standardized abbreviations are allowed if an explanatory key is included in the office manual. In contrast, the Massachusetts Board of Registry in Dentistry declared in 2010 that abbreviations were no longer acceptable. It is therefore advisable for dental practitioners to check with their specific state board or state regulations to determine whether abbreviations are acceptable. If a dentist dictates notes, the dentist should review the final copy and sign it. If a patient initiates a complaint, claim, subpoena, or malpractice charge, the dental record must never be altered in any way. Doing so may be construed as covering a wrongdoing or evidence of guilt. In addition, many dental malpractice insurance carriers have clauses that will disallow coverage if an insured alters a record. language other than English at home (Anderson et al., 2003; U.S. Census Bureau, 2010). There is a high probability that dental practices will treat patients from this culturally diverse pool, and many patients will not speak English as their primary language. Prudent practitioners should increase communication with their culturally diverse patients by: ● Employing bilingual staff. ● Using interpreter services. ● Having English-speaking family members accompany their patients. ● Providing signage and instructional materials in their patients’ native languages. ● Using culturally competent audiovisual products. ● Providing practice forms (including health histories) in multiple languages. ● Explain the drug’s use and dosage and indicate how often to take it. ● Explain how to take the drug properly, such as with a meal or on an empty stomach. ● Explain the actions that the patient should take if any side effects are experienced. Errors involving medications can include dispensing the wrong medication (perhaps one to which the patient has a documented allergy); prescribing the wrong dosage; misreading a medical consultation or laboratory report; failure to expediently prescribe an antibiotic; or inadequate infection control when administering an intravenous or intramuscular medication, resulting in the development of an infection. Many preventable factors (including being short-staffed, being hurried, and working long hours) contribute to a situation in which a medical error may occur (NCC MERP, 2014). ● Improperly labeled or mounted radiographs. ● Alternate (unfamiliar) tooth-numbering systems. The Oral and Maxillofacial Surgeons National Insurance Company (OMSNIC) Risk Retention Group has released data on its 4,300 members (Lee, Curley, & Smith, 2007) showing the prevalence and circumstances of wrong-tooth or wrong- site surgery. Claims were most commonly filed for paresthesia resulting from the placement of implants and third molar extractions, infection, and wrong-site tooth extraction. Although 14% of all claims resulted from wrong-site tooth extractions, these errors accounted for 30% of claims actually paid. The ● Extensively carious teeth that are part of the Comprehensive Treatment Plan. company identified communication problems within the surgeon’s office and with the referring dentists as the primary causes for many wrong-site surgeries. Neither a surgeon’s age
allows for continuity of care for the patient and is critical in the event of a malpractice insurance claim. The ADA Council recommends the following guidelines for proper charting methods: ● All chart entries should be objective in nature and present only the facts related to patient care. ● To avoid mistakes when dealing with complex treatment notes, write out the notes on a piece of paper before entering them in the chart. ● Complete all record entries as soon as possible following the patient care; never leave blank lines to fill in later. ● Initial, sign, and date all entries with legible handwriting, using black or blue ink that shows up well on a photocopy. ● To correct an entry, insert a single line through the mistake, then initial and date the correction; all corrections must be legible. Do not erase, use correction fluid, or obliterate the entry. Communication errors Good communication is often key to avoiding a malpractice charge. When patients establish a relationship with their dental healthcare provider, understand their treatment options, and feel confident in their choices, they are less likely to file charges of malpractice (Anderson et al., 2003). However, effective communication can sometimes be difficult in a culturally diverse population. The goal of all health care, including dentistry, is to provide culturally competent and appropriate services. Patient care quality can be compromised when patients do not understand their dental healthcare providers, the providers speak a different language, or the providers are culturally insensitive to their patients. The influx of immigrants into the United States over the past few decades has brought the number of languages other than English spoken in the country to 329. Currently, there are more than 55 million people in the United States who speak a Medication errors Providing dental care often involves prescribing medications for the alleviation of pain, anxiety, or infection. Many patients have complex medical histories and take multiple medications. Some patients are not accurate historians and inadvertently provide limited information regarding their current medications and allergies. These factors increase the probability that a medication error may occur. When prescribing medication for patients, the following recommendations apply: ● Review the patient’s medications, including vitamins, minerals, and herbal supplements. ● Assess all previous allergic reactions to medications, foods, or any other substances. ● Provide written and verbal information on the medication being prescribed to the patient. ● Document the name of the drug in the patient record, including whether the brand or generic version was prescribed. Surgical errors Even though anecdotal reports are common and there are known medicolegal implications, there are few studies regarding the prevalence of wrong-site tooth extractions (Chang et al., 2004; Jerrold & Romeo, 1991). However, it is widely believed that wrong-site tooth extractions are underreported, along with other dental errors (Canale, 2005; Brennan et al., 2004; Brennan et al., 2005). Reasons for wrong- site tooth extractions are varied and may include: ● Cognitive failure of the office staff and/or the patient. ● Miscommunication between the dental staff and patient. ● Miscommunication between the general practitioner and the oral surgeon. ● Numerous/adjacent carious teeth (instead of one easily identifiable diseased tooth). ● Partially erupted teeth mistaken as third molars.
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Book Code: DFL3024
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