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 Conclusion The problem of medical/dental errors is amazingly complex. Although some progress has been made in the form of technological advances and standardization, much remains to be done. Organizationally, solutions must be developed and discussed from both the top down and the bottom up. All aspects of health care must be included. Resources from senior leadership must provide for teamwork training, technological innovations, and appropriate staffing. Because much of the threat to patient safety occurs at the direct point of care, frontline staff must be empowered to identify and analyze errors without fear of retribution. Fostering a culture of safety is part of the broader movement to improve healthcare quality – along with assuring that care is effective, patient-centered, timely, efficient, and equitable. Fostering a culture of safety is an essential element in improving the U.S. healthcare delivery system, of which oral health is an integral part. Delivery of care involves physicians, dentists, nurses, pharmacists, and all auxiliary personnel such as
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. assistants and hygienists. The role that oral health professionals play in overall health is constantly growing, with newer screenings for HIV and HCV, in addition to more traditional screenings, such as those for blood pressure and diabetes. There are increasing opportunities for oral healthcare providers to participate more fully in preventive health care for their patients. There will always be room for improvement in creating a culture of safety in the dental setting as modern clinicians and dental office staff become increasingly aware of the importance of safety and infection prevention. A culture of safety calls for constant improvement and mindfulness on the part of everyone in the office. Quality initiatives must be implemented, and barriers identified and addressed. Constant monitoring on the part of the entire dental team must be a major part of the culture of safety and a daily concern. Furthermore, patients must play an active role in their own care. Working together, dental healthcare providers and their patients can ensure an environment of safe and high-quality care.
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