The Compliance Divas Podcast
Our podcast covers current topics such as infection prevention and control, OSHA and HIPAA compliance for dentistry. We discuss the latest regulatory information, answer frequently asked questions and give suggestions for dental practices to make compliance easy and sustainable. The Compliance Divas are a trusted source for consistent, accurate information based upon current guidelines, standards, science, and recommendations.
The Compliance Divas Podcast
#196 Patient Safety Hacks - What You May be Overlooking
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Patient safety is the cornerstone of excellence in dentistry. Ensuring that every procedure is conducted with the utmost care to prevent patient is our #1 goal during each patient visit. Today the Divas will share some patient safety hacks that we hope you'll find useful for your practice.
Resources:
- The Oklahoman Sept. 18, 2013 - OK says hepatitis C was spread at dental clinic https://bit.ly/4hsbCY9
- Law & Crime - Dec. 12, 2024, Multi-tasking for profit: Family sues oral surgeon after teen son dies during routing wisdom tooth procedure https://bit.ly/3QgRaNT
- KIRO News 7 Nov. 3, 2023 - Piercy County dentist suspended after patient dies allegedly from procedure https://bit.ly/43dIVdp
- MedPro Group June 4, 2024 - Patient Sues Dentist After Refusing X-Rays - Case study https://bit.ly/3WVIOPB
- Safco Dental Supply Blog - 5 Common Dental Equipment Mistakes & How to Prevent Them https://bit.ly/41oTNnr
Welcome. I'm Leslie Cannon. I'm Mary Gavoni.
SPEAKER_02I'm Linda Harvey. I'm Olivia Long, and together we are the Compliance Divas.
SPEAKER_03Welcome to the Compliance Divas Podcast. This is Linda Harvey, and I will be your moderator for today's episode. Today, the Divas will be talking about safety hacks for dental teams. And as the Compliance Divas, we bring clarity and simplicity to compliance to help navigate your regulatory world. We invite you to subscribe to our podcast on your favorite podcast channel or on our website at compliancedivas.com. Anything that we mentioned today in our program will be found in the show notes as far as all the resources. And we invite you to submit your questions to support at the compliancedevas.com. And we also invite you to scroll down at the end of this podcast and give us a rating or a like. Well, when you think about patient safety, it truly is the cornerstone of dentistry and all of healthcare. Ensuring that every procedure is conducted with the utmost care to prevent patient harm is our number one goal during each patient visit. Yet sometimes in our busy days, we get distracted by situations such as being short-handed and you're stressed or running behind schedule because all you can think about are those two patients sitting in the reception room. So how do you stay grounded and present in the moment while caring for the patient in your chair? Today the divas are going to share some patient safety hacks, and we hope that you'll find these useful for your practice. I'd like to call on our diva Leslie first. Leslie, could you talk to us a little bit about sterilization? And I know we've done numerous podcasts on different topics of sterilization, but I'd like to just put a fresh eyes to this and think about patient safety and sterilization, please.
SPEAKER_00Well, you know, Linda, there have been events that have brought attention to dental practice sterilization techniques with regards to breaches that have occurred. And the one breach that I remember very uh clearly was back in 2013 in Tulsa, Oklahoma. It was our first hepatitis C transmission from a dental practice to a dental patient. It was an oral surgery practice, the practice of Dr. Scott Harrington. And in this particular event, there was the public health department was notified when a patient came up with hepatitis C, he diagnosed, but didn't really have the risk factors for being an individual who would be one that would be likely to get hepatitis C. In fact, he was a routine blood donor, so it really raised a big red flag that he would have acquired hepatitis C. And upon interviewing him, the public health department discovered that he had had oral surgery recently. So, along with the Oklahoma Dental Board, the public health department went to the dental office of Dr. Harrington and found a number of red flags, so to speak, with regards to infection control and sterilization. And while the transmission was not to thought to have occurred through sterilization procedures, it was due to unsafe injection practices. As they were doing their audit, they found dirty and rusted instruments that were corroded. They found that the dental team didn't really have a great concept of how to sterilize instruments. In fact, there was a misconception that they would have to soak instruments in undiluted bleach if they had a patient who had been diagnosed with hepatitis or HIV, and they handled those instruments differently, which of course, standard precautions state that we treat all instruments and all blood and body fluid as though it's potentially infectious. So in addition to mishandling the how they process instruments, they also were not honoring the standard precautions where all instruments, whether we know a person's diagnosis of hepatitis or HIV or not, we treat all instruments the same and sterilize them the same. They also had not conducted spore testing in more than, as I understood it, five years. Quite a long time to not do spore testing. So they weren't even validating whether their machine was working. I would encourage everybody who's listening today that you are spore testing. CDC is recommending that, of course, once a week. And some facilities do it more often, some do it daily, but that you have your results of those if you are mailing away to a third party, that you open the emails when you get the responses, look at it, file it in a folder that shows that somebody did indeed review the sterilization spore testing results. Also, what they found in Dr. Harrington's office was that they found that the team members were not doing as good of a job with infection control as they should be. So infection control training is certainly going to prevent errors when it comes to sterilization and disinfection of patient care surfaces and treatment room. Some of the other things that we hear is in the news there was another event where a dentist had been actually investigated more than once in the state of Tennessee where Diva Olivia lived. And what they said was grossly unsanitary conditions of the dental practice. Now, in this case, the dentist had not changed his gloves between patients. We used crowns previously used on other patients and appeared to be under the influence of something during several patient visits. But these things are egregious. There's other things that they found that I think we might be overlooking sometimes when it comes in in our dental settings and what patients see, they found bloody gauze on the floor and they found a dirty sink and crushed it with grime. And then the hand pieces that weren't wrapped or sterilized, they were actually hanging on the chair side or on the unit, but then also on the extremely dirty floor beside the unit as it was described. So, in making sure that we protect our patients, we want to make sure that infection control is top of mind that we're following not only CDC guidelines, but also state regulations for sterilization and disinfection of patient care items and surfaces.
SPEAKER_03Listen, that's a great recap and emphasis on the importance of sterilization. So thank you for shedding a little bit different light with those cases. And while they were quite egregious, thankfully they don't happen every day. But it does bring to mind that we should be careful not to be slack and not to skip steps or be in a hurry. I know sometimes, as I mentioned in my opening, that we get behind, we start running behind with our schedule, or we're worried that our patients are waiting too long, or the doctor is impatient, or whatever the situation might be. But we need to take the extra few seconds. It's not like we're talking about half an hour, but extra few seconds sometimes just to make sure you're following an instrument process or disinfection step properly. And that also it's important to treat all patients the same. Just because we know a patient has HIV or has hepatitis B, we have to treat all patients the same. And that's been the standard precaution for years now. And even though the case in Oklahoma goes back to 2013, Leslie, I just want to thank you for bringing that to the attention of our listeners today because we may have some folks joining us who are newer to dentistry and never heard about that case. So disease transmission is definitely possible in dental settings. Thanks, Leslie. Olivia, can I ask you to talk about another area of patient safety real quick?
SPEAKER_02This is certainly a topic that concerns me. It's a little bit scary. And it's really so needed. Because if you think about it, sedation dentistry benefits patients whether they're very young or adults, those that suffer with dental phobias, or they have anxiety, or even if they have a sensitive gag reflux, it's certainly something desirable and needed. Back when I worked in a dental office, we use nitrous oxide and we understand how safe it is to use nitrous. But what gets a little bit more scary is oral conscious sedation, where medication is prescribed, such as diazepam. You know, once they ingest the pill, it's there. Now, would the attending professional dentist have the training if there was an adverse reaction? So we have oral conscious sedation and then intravenous IV sedation. I had a case that came to me uh probably a year ago where the patient was sedated and had an adverse response. And my question was, you know, why not bring in an anesthesiologist if this is not the area that you're accustomed to working in? And of course, at that point I learned how expensive it is to do that. But we do have a case where a teenager actually died following having a wisdom tooth extracted at an oral surgeon's office where there was an adverse response. And so the the point of it is that are we taking the time, let's say we're going to do IV sedation or even oral sedation. What is the time that we're investing in communicating with the patient's healthcare professional? Do we even have an accurate medical history? Are we bringing in that insight into diagnosing a patient and what are the risks and the benefits, whether that is an advantage for the particular patient to be sedated? And do we really understand what those complications are and how to offset it? Now, in the case that I mentioned about the teenager, his family sued the oral surgeon for malpractice and negligence. And the lawsuit alleged that the oral surgeon did not bring in an anesthesiologist to maximize profitability. So the oral surgeon was functioning in the capacity of the oral surgeon and the anesthesiologist performing both services. And what happened in this incident is that the patient's airway was closed for several minutes. And this resulted from this oral surgeon choosing to wear two hats, so to speak, and the patient was not given the life-saving care, nor were his needs responded to properly. So I think this is a good discussion to look at on being vigilant about obtaining an accurate medical history and clearance from the physician. In my mind, I think about elderly patients, they may not have the accurate medical history to share. They may not think, oh, diabetes, well, it how important is that to the dentist or some other complicating medical issues that they're not discussing with their dentist? So although it would take extra time to reach out to the attending physician, it's part of risk management and making sure we have accurate information before we sedate someone, especially with IV sedation, Linda.
SPEAKER_03Thank you, Olivia. You raised some very important points. And to me, what as a risk manager, what jumps out is we were talking about this oral surgeon was performing multiple roles and he was multitasking. And evidently somebody was not monitoring the patient well during this process. So it kind of raises the question well, where was the dental assistant or dental assistance? And I know that in every state to have a sedation permit, the requirements might vary from state to state and always pays to be safer. So don't just look at your minimum requirements that your state sets forth that you have to pass, but go up a little bit more just to be careful. Have that extra dental assistant in the room, have someone who's dedicated to watching the patient. I know a lot of oral surgery offices that I work with send their dental assistants to get certified and what's known as dance, the DAANCE criteria or certificate that teaches them all about pharmacology so they can be more in um in tune with the different medications that's used in the practice. But also also I love the fact that you mentioned, you know, getting a thorough medical history. And that's one thing that's lacking in dentistry. When you just think about at a bigger picture for a moment, when we transfer records between practices, we're probably mostly just transferring x-rays. And a lot of times the off the new office or the referral, like the oral surgeon, is still taking their own. So there's not much that gets transferred in the way of thorough patient records, especially the medical history. And that's one that really needs to be taken care of carefully and very cautiously, because that's a very sad circumstance when a patient has an adverse event that happens, and especially if the patient expires, very sad indeed. So keep it, that's another hack that we want everybody to be mindful of. Mary, I think the topic that I'd like to ask you to speak about kind of circles back into what Olivia was talking about, and that is just referrals. How should offices be tracking referrals so patients don't fall in the cracks and have issues that happen, disease?
SPEAKER_01Well, thank you, Linda. We know that it's a regular activity in dental practices referring patients out, especially if there's maybe a suspicious lesion that we want the oral surgeon to evaluate. And if we don't have a system where we actually call the specialist and set that appointment up before the patient leaves the practice, then we're simply relying on the patient to take that referral slip and to call the specialist. And a lot of times it just gets dropped there. So the patient's been perhaps in the practice for their recare visit. The hygienist and the doctor notice something, they make the referral, and oh, now it's six months later, and the patient comes back again. And oh yeah, I forgot to make that appointment, I didn't do it. And as we know, oral cancer has a lot of um risks associated with it. So I think it behooves a practice to have a follow-up system, whether it is email or secure texting through a HIPAA compliant app or phone calls that someone, maybe it's the patient care coordinator, someone follows up with a determined amount of time. Maybe you give them a week and you follow up to make sure that that patient has scheduled that appointment and communicate also perhaps with the specialist that here is someone that we've referred and we hope that they will be scheduling their appointment. But I think that it's really a valuable tool if the patient will be compliant, is try to get them to schedule that appointment right when they're there. But even following up with patients based on treatment, if we are recommending, for example, for periopatients, they've had their scaling root planing periotherapy, and we are recommending that they use an automatic toothbrush or a water flosser or something. What kind of follow-up are we doing with that patient to make sure that they've done it? I know I've read in a couple of studies that 80% of the people who buy or get a mechanical toothbrush from their dentist don't even use it. They don't even take it out of the box. So those kinds of follow-ups need to happen. And another one, which is a risk management tool, if a patient fails an appointment, especially for treatment, what are we doing to follow up with them to make sure that they get rescheduled for treatment or we note that they have declined the treatment? Those are huge issues, so that the dental practice doesn't end up getting sued for negligence. And a couple of other things to think about. And I know this just opens up a whole can of worms about what about the patient that refuses x-rays? And we have them sign their chart or we have them sign off saying that they refuse. And that's a risky thing to do for any length of time because now you can be liable for failure to diagnose or failure to give a thorough and accurate assessment on your patients. So those kinds of patients who perhaps refuse x-rays may need to be, and it's a long involved conversation and process, but they may actually need to be dismissed from the practice because you're not providing adequate care for them. So, you know, we could go on for hours talking about all these various safety issues, and they're out there. We just tend to not think about them.
SPEAKER_03That's so true, Mary. We tend to not think about them because we get busy in our busy day. Is our schedule filled? Do we meet production? Do I have enough instruments? Do I have enough supplies? Is all are all my team members here today? You know, there's so many things that go into running a dental practice successfully. And I liked how you mentioned about having multiple touch points with the patient to ensure one that they've made that referral and they follow through on it and they understand that a suspicious lesion could be very concerning, and as well as that missed appointment. So there's no negligence or even an appearance of abandonment with that patient. Mary, you had some other thoughts on that too?
SPEAKER_01Yeah, I meant to mention earlier that many of the subscription services that practices use that are patient communication tools like Weave and Solution Reach and others have those kinds of mechanisms built into them and take advantage of that for follow-up with patients because it's easy. It can be done as a secure text, it can be done as a secure email or last resort, could be a phone call.
SPEAKER_03So true, so true. And so true about that, Mary, is now I believe now you have defensible documentation when you have those doc whether it's emails, phone calls, recordings, whatever, that kind of add to the last topic that I wanted to bring us into. And that's just inadequate chart documentation. That's a big safety hack for patients. Sometimes we get into the habit of using these great templates that either already come with your software program or the office has gone to the trouble of creating some custom templates and they can be two cookie cutters. And even though the patient may only be having a class one recare appointment, every patient's still different. There's something about every patient that's different. So when you look at back historically through a patient record, those notes, if they look the same every six months, it looks like it's just a copy and paste. And I've had many attorneys tell me that over the years, I've had the opportunity to work with a lot of dentists that have been disciplined by their regulatory board over some kind of patient complaint. And nine times out of ten, it's not a standard of care issue, it's a record keeping issue the board finds. So we don't clearly have our diagnosis noted. We don't clearly note that we've informed the patient of the diagnosis, and we haven't clearly, you know, discussed with the patient the prognosis, if there's any, you know, such a period that you mentioned, Mary, there, the prognosis could be questionable on a tooth or a few teeth. So these are such important areas to really just shine a different light on patient safety, everything from sterilization to sedation and medical histories and following up with your patients. And I know we put so much heart into our work that it can be, it may seem tedious sometimes to have to follow up with our patients. But let's let's lead with our hearts and dentistry and make sure that we're really giving our patients our best. And if all else fails and you have a patient that you are not sure how to handle or what to do, call your professional liability carrier. They are your best friend. And if you ever get any complaints from the Board of Dentistry, no matter how innocent you think you are, please, I would recommend, just as a piece of risk management suggestion here, not legal advice by any means, but to contact your carrier. Don't ever respond to any requests for records or information without speaking to an attorney to have coverage and make sure you're doing everything properly. So these are some tips that we could help with our listeners today. I hope you all take these hacks back to your practice and discuss them at some team meetings. There's certainly enough information to talk about through several meetings and that you'll implement these to improve and maintain patient safety in your practice. As the compliance divas, we bring clarity and simplicity to compliance by navigating the regulatory world to keep you on course. We invite you to subscribe to our podcast through your favorite podcast channel or on our website, thecompliancedivas.com. The resources that we talked about today, especially the juicy cases that we discussed, we'll put those links in our show notes for you. And we invite you to scroll down and leave us a like or review. And your questions are always welcome to support at thecompliancedivas.com. We look forward to seeing you next time.