patient safety aspect for dental health care setting in view of dental patient safety

1. PATIENT SAFETY
Dr. Rashmi kulkarni
QUALITY MANAGER
INTERNAL AUDITOR FOR NABH & NABL
SRI AUROBINDO MEDICAL COLLEGE& PG
INSTITUTE INDORE

2. ORIGIN OF PATIENT SAFETY
CONCEPT
 PART OF HIPPOCRATIC OATH
 I will prescribe regimens for the good of my patients
according to my ability and my judgment and ”never do
harm” to anyone.

3. WHAT IS PATIENT SAFETY?
 Patient safety is the absence of preventable harm to a
patient during the process of healthcare.
 The meaning of patient safety is…“Please do no harm”
• Eliminating preventable medical mistakes by care givers
Guarding against the impact of human error
• Establishing systems to safeguard patients' health and
well-being
 ACCIDENTS ,ERROR & COMPLICATIONS

4. ORGANIZATIONS FOR
PATIENT SAFETY IN DENTAL
• World Dental Federation
• Dental Patient Safety Foundation
• INDIAN DENTAL COUNCIL
• The Council Of European Dentist
• Organization For Safety, Asepsis And
Prevention
• In Spain, Spanish Observatory For Dental
Patient Safety (OESPO)
• Etc

6. Type of Harm Example of Patient Harm
Delayed appropriate treatment/ disease
progression and/ or unnecessary treatment
associated with misdiagnosis
Melkersson-Rosenthal syndrome
misdiagnosed as angioedema and dental
abscess resulting in multiple tooth
extractions
Other systemic complications including
adverse reactions to dental
device/material/procedure
Intracerebral hematoma after tooth
extraction
Allergy/ Hypersensitivity reactions
Latex allergy (bitewing radiograph pack,
rubber dam, prophylaxis cup)
Systemic infection Cerebral abscess after dental procedure
Soft tissue injury/ inflammation
Accidental injection of formalin into soft
tissues instead of local anesthetic
Aspiration of foreign body Aspiration of rubber mouth prop
Nerve damage or injury Paresthesia of infraorbital region
Retention of foreign object(s) with
sequela(e)
Breakage of surgical bur and retention
within bone

7. Type of Harm Example of Patient Harm
Hard-tissue damage
Root perforation during endodontic
treatment
Psychological distress/ disorder
Anorexia nervosa induced by painful
orthodontic treatment
Toxicity/ drug overdose
Injection of 1:1000 adrenaline versus
1:100,000
Orofacial infection
Necrotizing fasciitis of infraorbital
region
Poor hemostasis/ prolonged bleeding
After traumatic tooth extraction in
hemophiliac patient
Ingestion of foreign body Ingestion of endodontic file
Other orofacial complications
Tear of suspensory ligaments in
temporomandibular after excessive

8. MAGNITUDE OF PROBLEM:
• Lack of Awareness – Patient Safety Not Priority
• Lack of Baseline Data
• Lack of Availability of A System For Patient Safety
 Senior leadership
 cover up policy
 Inadequate & Overloaded Staff
• Lack of Dedicated Financing
• Resistance To Change
• Culture of Blame

9. AIMS OF THIS INITIATIVE
• A successful, healthy outcome of patient care
• Safe, error-free care
• The most expert and advanced Dental care available for patients
• Comfort and peace of mind for patients and providers

10. PERFORMA'S
• Check list for safety of surgical patients
• Patient safety evaluation
• Adverse Event Reporting Performa
• Incidence form

11. KEY POINTS
• Develop a culture of safety and a health care system
focused on prioritizing patient safety.
• Look after the quality of clinical records.
• Check the procedures for cleaning, disinfection, sterilization,
and preservation of clinical instruments.
• Exercise extreme caution when prescribing medications.
• Limit the exposure of patients to ionizing radiation only to
what is strictly necessary.

12. KEY POINTS
• Never reuse packaging materials or substances intended for one clinical
use only.
• Protect the patient's eyes during dental procedures.
• Establish barriers to prevent ingestion or inhalation of materials or small
instruments.
• Use a checklist in all oral surgical procedures.
• Monitor the onset and progression of infection in the oral cavity.
• Have an action protocol for life-threatening emergencies in the dental clinic.

13. SAFETY COMMITTEE
Sr. No. Designation Designation in Committee
1. DEAN Chairperson
2. Safety Officer (CLINICAL &
FACILLITY )
Convener
3. Quality manager Member
4. Radiation safety officer Member
5. Laboratory safety officer Member
7. Fire safety officer Member
6. Infection control nurse Member
7. Administrative officer Member
8. Maintenance In- charge Invitee Member
9. Bio - Medical Engineer Invitee Member
10 Security Head Invitee Member

16. Accurate Patient identification.
 Toensure the correct identity of
the patient at all times and
before undergoing procedures
 to provide accurate
identification of patients
there by minimizing s
related clinical error and
patient harm.
 Medication Error
 DENTURE MAKING
 Testing Error
 Wrong Person Procedure

18. EFFECATIVE
COMMUNICATION

20. KEY POINTS
• Medical History
• Correspondence From Other Healthcare
Professionals
• Examination And Test Results
• Radiographs
• Photographs
• Treatment Options
• Treatment Plan
• The Informed Consent Process.

22. Medication safety

23. PHARMACOVIGILANCE
SAFE DRUG PRESCRIPTION
AN ADVERSE EVENT REPORTING CELL

24. MEDICATION SAFETY
 Illegible Writing prescription by doctors.
 Wrong medicines or wrong does or wrong patient.
 Wrong injection and wrong route of administration.
 Clear & legible written medication guidelines.
 Identification of each patient with Similar patient names
 High risk drugs
 Look alike and Sound Alike “LASA”
 Food drug interaction
 Drug –drug interaction

25. MEDICATION SAFETY
• Errors in the indication for the drug (in relation to the type
of drug, dose or duration of treatment)
• Allergic reactions that occur because of a lack of adequate
medical records
• Drug interactions that occurs because the prescribing
practitioner lacks the relevant pharmacological knowledge
or fails to update the list of drugs taken by the patient
• Wrong dose of the drug (especially common in children and
in patients with alterations in the metabolism or
elimination of drugs)
• Duplication of drugs (especially common with anti-
inflammatories) because of a lack of coordination among
the various professional prescribing for the same patient.

27. Reduce the risk of Hospital
associated infections.

28. HIC
• HOSPITAL ASSOCIATED INFECTION
Surgical site infection rate
• POST EXPOSURE PROPHYLAXIS
• Needle stick injury
• Blood & body fluid exposure

29. SANITATION- INFECTION
CONTROL- BMW DISPOSAL
 Sanitation BMW HAI Disposal
 Proper segregation & transportation of biomedical wastes
 Sanitation & hygiene of different parts of hospital to avoid
infection
 Use of sterile procedures
 Safety in use of incinerator, autoclave, shredder, needle
destroyers and proper disposal of biomedical waste.
 Formation of hospital infection control committee
 Investigation of all hospital infections
 Use of proper antibiotics in right doses in right time
 Reorientation of Resident doctors & Nursing staff

34. RISK ASSESSMENT

35. Risk assessment
• With Poorly Controlled Diabetes
• With A Cognitive Impairment Such As Dementia
• Who Are Immune-suppressed Or Compromised
• Who Are Taking Anticoagulants Or
Bisphosphonates.
• Vulnerable Patients

36. Risk assessment
• Failure to check PMH
• Inhaling or swallowing crown or instrument
• Restoring the wrong tooth
• Extracting the wrong tooth
• Iatrogenic damage to adjacent tooth
• Allergic reaction due to not checking PMH
• Using dirty instruments
• Delay in sending urgent referral
• Delay in sending routine referrals
• Treating the wrong patient
• Oxygen and emergency drugs not available

37. Failure to check PMH Extreme risk
Inhaling or swallowing crown or instrument High risk
Restoring the wrong tooth High risk
Oxygen and emergency drugs not available High risk
Extracting the wrong tooth High risk
Allergic reaction due to not checking PMH High risk
Iatrogenic damage to adjacent tooth Moderate risk
Using dirty instruments Moderate risk
Delay in sending urgent referral Moderate risk
Delay in sending routine referrals Moderate risk
Treating the wrong patient Moderate risk

38. CODES

39. Accidents
1. The patient falls (due to poorly organized
furniture, architectural barriers, slippery
floors, etc.)
2. Heavy or sharp instruments or apparatus fall
on the patient
3. The patient suffers accidental cuts and burns
4. The patient ingests/inhales small dental
material
5. The patient suffers eye damage.

40. RADIATION SAFETY

41. • All exposures should be kept As Low As is Reasonably Achievable,
(ALARA) economic and social factors being taken into account.
(Optimization)
• The dose equivalent to individuals shall not exceed the limits
recommended for the appropriate circumstances. (Limitation)
• Time of exposure, Distance of exposure and Shielding to be
appropriately defined
Basic Principles of Radiation Protection

43. Surgical Errors
• Errors in treatment planning (sometimes associated with lack of adequate
clinical records previous to treatment)
• Errors in the type of procedure performed (motivated by incorrect patient
identification or inadequate clinical history)
• Errors in the area of intervention (Wrong-site surgery) that occur as a
result of forgetfulness or the inappropriate interpretation of records by
the professional
• Errors in pre-operative prophylaxis in medically compromised patients
• Errors in the monitoring and control of operated patients (no post-
operative instruction sheet or lack of post-surgical control)
• Post-surgical infections (detected late or inadequately treated).

44. Surveillance of surgical
site infections
• Risk factors
• Hand washing
• Presurgical skin disinfection
• Special cases for decontamination
• Antibiotic prophylaxis
• Minimizing contamination in the operating
room
• Guaranteeing the sterility of surgical
instruments: sterility indicators

45. SURGICAL SAFETY
• Correct patient, operation and
operative site
• Safe Anaesthesia
• Minimizing risk of infection
• Effective Teamwork

46. WHO SURGICAL SAFETY CHECKLIST

47. ENVIRONMENTAL SAFETY
 Adequate light
 Adequate ventilation, exhaust fan
 Stairs with hand rails
 Window-door-closer
 Slip preventing floors
 Fire extinguishers and fire alarms
 Prevent noise pollution
 Safe wheel chairs and trolleys
 No water logging in bathrooms

48. FIRE SAFETY
 Use Fire proof material for construction.
 Have Fire Exit in all Buildings.
 Smoke detectors and water sprinklers on the roof of all
Floors.
 Fire Extinguishers in all areas.
 Fire Hydrants in all buildings.
 Training in Fire management

49. TIPS FOR IMPROVING
PATIENT SAFETY
 Constitution of Patient Safety Committee.
 Develop clear policies and protocols for patient safety.
 Discuss regularly patient safety initiative within hospital
staff.
 Orientation, Re-orientation hospital staff on patient safety
 Each department to devise their own patient safety
protocols.
 Investigate each accident/ incident reported and take
remedial measures.
 Review, monitor & evaluate. safety procedures regularly.

50. PATIENT SAFETY CULTURE
• Understanding our current situation
• Recall and analyze adverse events encountered
• Check correctness of 20 medical records chosen at random
• Review our protocols for cleaning and sterilizing non-disposable
instruments
• Review our protocols for action in a life-threatening emergency.
• Establishing “Safety Instructions” (red lines)
• Never re-use containers designed for single-use only
• Do not perform Root Canal Treatment (RCT) without rubber dam
• Never prescribe any drug without consulting patient clinical record
and without directly asking the patient about allergies or other
health problems