Many of the  advertisements we see in magazines and on television are chock full of teeth whitening and lipstick products bringing attention to the mouth and teeth. It is a well-researched fact that the concept of the healthcare continuum includes optimum oral health. Without a healthy mouth and teeth, systemic illnesses can evolve and  quality of life can surely go down.

The hygienist is an important component of the culture of the dental practice as well as the patient safety error culture. Customers/patients have a choice and can use a different hygienist in the dental office or in a different dental practice. There are direct and indirect aspects of customer/patient service that include patient relationships, professional technique and value added services. Patient safety is often an unrecognized value added service within the practice.

History lesson

The 1999 Institute of Medicine (IOM) report, To Err is Human, reported that between 44,000 and 98,000 patients die annually from medical errors in the U. S. This translates to the eight leading cause of death in the country. A second IOM report estimated that medication errors alone account for more than 7,000 deaths, in or out of a hospital. While these two reports do not include the dental setting, some aspects of healthcare delivery are applicable and can be extrapolated to the dental setting.

Dental practitioners became acutely aware of patient safety and employee safety concepts of prevention when it was recognized that disease could be spread through the aerosols and droplets created by the high-speed handpiece and ultrasonic devices, or through other exposure to contaminated blood or bodily fluids. Use of face masks and other face protection, gloves and other body barriers are now common, and the conversion from cold sterilization of dental instruments to autoclaving is now the standard. Such patient safety practices protect not only the dental staff, but also prevent transmission of disease from patient to patient.

A dental hygienist’s practice that incorporates the overall concept of patient safety as a regular component of all activities reflects quality care to the patients. Such a reputation of quality dental care in the community will go a long way to lay the foundation to prevent the development of error and other situations that could lead to malpractice claims and complaints.

another kind of risk assessment

Patient safety is risk management in disguise. Risk management’s focus is to identify and reduce or eliminate risks, thereby increasing patient safety. This initiative is not the responsibility of just one person in the dental practice, although it often falls to one person to be the point person or leader of the program. Who better to serve in this role than the dental hygienist? Patient safety is a component of the larger risk management program. Both patient safety and risk management focus on prevention of errors. Risk management is broader in that it includes claims management and risk financing (how claims will be paid).

A patient risk management and safety program encompasses all aspects of the dental practice business: property, equipment, technology, personnel, patient care, operational and business practices, as well as legal and regulatory issues. To ignore any one of these components may result in risk exposure that could negatively impact the practice . (For a list of specific things to check for in each of these areas, e-mail tcarter@advanstar.com.)

A patient safety/risk management program is a proactive, non-punitive program that focuses on processes, not on an individual. That does not mean there should not be professional accountability, since everyone is responsible for their own actions. Instead, it means focusing on the Root Cause Analysis (RCA) process to determine why the error occurred. The “why” is important because that leads to correction and prevention.

Finding the Why

Using the RCA or the Failure Mode and Effects Analysis (FMEA) methodology are helpful tools in finding the “why.” Briefly put, these processes look at the process as it should have happened and then at the process as it actually happened—this is not about casting blame, but preventing recurrence. After comparing the two processes, ask why there were deviations until the root cause is identified. It could be lack of or incorrect communication, insufficient training, failure of management to periodically assess personnel competence, etc.

taking responsibility

While the majority of malpractice claims arise from the medical and acute care field (as reflected in the IOM report), that does not mean the dental industry can ignore patient safety and risk management loss prevention practices. Dental/oral health is growing in recognition as an important component of total body health. As medical and dental technology continues to evolve so will the risks and a greater need for patient safety, risk management, and emphasis on loss prevention.

The discussion above is an overview of some of the many areas to be addressed in establishing a culture of safety and error prevention in the dental practice.

The dental hygienist is often first in the process of establishing a positive patient relationship. As the designated patient safety point person the dental hygienist plays an important role in establishing the framework for a practice to develop a reputation of safe quality dental care through an error prevention program.