The complexity of patient safety reporting systems in UK dentistry

A 5-Year retrospective analysis of adverse events in dentistry at the Dental Hospital, Faculty of Dentistry, Chulalongkorn University

BACKGROUND

Patient safety is a critical concern in dentistry. Adverse events (AEs) can harm patients, increase costs, and decrease satisfaction. Understanding AE types and frequencies is crucial for effective risk management and quality improvement. This study analyzes incident reports to identify preliminary incident patterns as a starting point for developing risk management strategies. However, under-reporting limits the ability to identify true incident patterns, highlighting the need for improved reporting systems and encouragement of incident reporting. Further research is underway to develop such a system and promote reporting to ensure sufficient data quality for effective risk management.

METHODS

A retrospective analysis of 1,618 incident reports from December 2018 to August 2023 was conducted. A validated classification system, developed from a 5-year retrospective analysis and approved by 14 experts, categorized patient safety incidents, aligning with Thailand's Hospital Accreditation standards. Descriptive statistics summarized AE frequency and distribution.

RESULTS

Of the reports, 752 were patient safety, 503 personnel safety, and 363 organizational safety incidents. Top patient safety incidents included medical record errors (176), accidental damage (66), post-operative complications (65), medical emergencies (64), and communication errors (53). Personnel safety incidents involved inappropriate working conditions (135) and work-related injuries with contact transmission risk (117). Organizational safety incidents mainly concerned policy and operational processes (131).

CONCLUSIONS

This study reveals the preliminary patterns of adverse events (AEs) in dental settings and underscores the limitations due to under-reporting, which affect the ability to fully understand true incident patterns. To effectively manage risks, there is a critical need for improving the existing incident reporting system and encouraging a culture of comprehensive reporting among dental professionals. Future efforts should focus on enhancing reporting systems to ensure high-quality data, enabling better identification of incident trends and supporting targeted risk management strategies to improve patient safety in dentistry.

Understanding patient safety in dentistry: evaluating the present and envisioning the future-a narrative review

BACKGROUND

Patient safety is crucial in dentistry, yet it has received delayed recognition compared with other healthcare fields. This literature review assesses the current state of patient safety in dentistry, investigates the reasons for the delay, and offers recommendations for enhancing patient safety in dental practices, dental schools, and hospitals.

METHODS

The review incorporates a thorough analysis of existing literature on patient safety in dentistry. Various sources, including research articles, guidelines and reports, were reviewed to gather insights into patient safety definitions, challenges and best practices specific to dentistry.

RESULTS

The review underscores the importance of prioritising patient safety in dentistry at all levels of healthcare. It identifies key definitions and factors contributing to the delayed focus on patient safety in the field. Additionally, it emphasises the significance of establishing a patient safety culture and discusses approaches such as safety plans, incident management systems, blame-free cultures and ethical frameworks to enhance patient safety.

CONCLUSION

Patient safety is vital in dentistry to ensure high-quality care and patient well-being. The review emphasises the importance of prioritising patient safety in dental practices, dental schools and hospitals. Through the implementation of recommended strategies and best practices, dental organisations can cultivate a patient safety culture, enhance communication, mitigate risks and continually improve patient safety outcomes. The dissemination of knowledge and the active involvement of all stakeholders are crucial for promoting patient safety and establishing a safe dental healthcare system.

Interplay between leadership and patient safety in dentistry: a dental hospital-based cross-sectional study

OBJECTIVES

The study aimed to study the association of leadership practices and patient safety culture in a dental hospital.

DESIGN

Hospital-based, cross-sectional study SETTING: Riphah Dental Hospital (RDH), Islamabad, Pakistan.

PARTICIPANTS

All dentists working at RDH were invited to participate.

MAIN OUTCOME MEASURES

A questionnaire comprised of the Transformational Leadership Scale (TLS) and the Dental adapted version of the Medical Office Survey of Patient Safety Culture (DMOSOPS) was distributed among the participants. The response rates for each dimension were calculated. The positive responses were added to calculate scores for each of the patient safety and leadership dimensions and the Total Leadership Score (TLS) and total patient safety score (TPSS). Correlational analysis is performed to assess any associations.

RESULTS

A total of 104 dentists participated in the study. A high positive response was observed on three of the leadership dimensions: inspirational communication (85.25%), intellectual stimulation (86%), and supportive leadership (75.17%). A low positive response was found on the following items: 'acknowledges improvement in my quality of work' (19%) and 'has a clear sense of where he/she wants our unit to be in 5 years' (35.64%). The reported positive responses in the patient safety dimensions were high on three of the patient safety dimensions: organisational learning (78.41%), teamwork (82.91%), and patient care tracking/follow-up (77.05%); and low on work pressure and pace (32.02%). A moderately positive correlation was found between TLS and TPSS (r=0.455, p<0.001).

CONCLUSIONS

Leadership was found to be associated with patient safety culture in a dental hospital. Leadership training programmes should be incorporated during dental training to prepare future leaders who can inspire a positive patient safety culture.

Hospital dental staff attitudes to guide education and training in patient safety: a study with a focus on qualitative data

Objectives This study aimed to determine attitudes of current NHS dental hospital trainees at dental core trainee and speciality registrar level, plus consultant trainers, to guide shaping the direction of education and training in patient safety. The study was a locally based project in a single dental hospital setting at an acute NHS London Trust.Methods This study employed a survey and interviews, with emphasis on qualitative data utilised. Interviews were aimed at hospital clinical dental staff. The survey and focus groups were aimed at trainees. The one-on-one interview sessions were aimed at trainers.Results Findings demonstrated that both trainers and trainees see patient safety as a priority and there are gaps in education and training. Four overarching themes were seen as important to trainees and trainers to support education and training in patient safety: culture, knowledge, time to train and engagement.Conclusions Recommendations in this dental hospital setting focused on culture change and dental-specific experiential learning based on spiral curricula. Education and training in patient safety should be introduced at undergraduate level, with regular team training acknowledging the need for consistent engagement of all key stakeholders.

Patient safety in dentistry - the bigger picture

Background Patient safety incidents (PSIs) have recently become a topic of discussion within dentistry. NHS England data has highlighted that wrong tooth extraction is the most common surgical Never Event (NE); however, this data reflects mainly a secondary care picture. Consideration needs to be given to reporting of PSIs occurring in primary care.Aims To establish the current attitudes of both primary and secondary care dentists within this field and to use this to promote a positive, supportive culture.Methods A national electronic survey was sent to dentists for data capture related to this topic, from April to September 2019 inclusively.Results There were 104 responses to the survey. Responses included that 39% of responders were general dental practitioners (GDPs), 90% were aware of NEs, 48% were not aware of how to report PSIs and 74% of dentists felt that fear of the General Dental Council/Care Quality Commission repercussions was a barrier to them reporting PSIs. Additionally, 86% of dentists felt that a trainee/GDP support network would be useful to share learning regarding PSIs.Conclusion The survey results highlighted that there is a lack of knowledge concerning PSI reporting, combined with a culture of fear of the repercussions of reporting. The survey data will aim to be used to implement a supportive network for dentists, develop a positive ethos surrounding PSIs and optimise patient care.

Perspectives of Dental Patients About Safety Incident Reporting: A Qualitative Pilot Study

OBJECTIVES

Patient reporting of safety incidents is one of the hallmarks of an effective patient safety protocol in any health care setting. However, very little is known about safety reporting among dental patients or effective strategies for engaging them in activities that promote safety. The goal of this study was to understand the perceptions of dental patients about the barriers and benefits of reporting safety incidents. We also sought to identify strategies for improving patient reporting of safety incidents in the dental care setting.

METHODS

We conducted 3 focus group sessions with adult dental patients (n = 16) attending an academic dental center from November 2017 to February 2018. Audio recordings were transcribed and analyzed using a hybrid thematic analysis approach with NVivo software.

RESULTS

Dental patients mainly attributed safety incidents to provider-related and systemic factors. They were most concerned about the financial implications, inconvenience of multiple visits, and the absence of an apology when an incident occurred. The major recommended strategies for engaging patients in safety-related activities included the following: proactive solicitation of patient feedback, what-to-expect checklists, continuous communication during visits/procedures, after-visit summary reports, clear incident reporting protocols, use of technology, independent third-party safety incident reporting platforms, and a closed feedback loop.

CONCLUSIONS

This study offers a roadmap for proactively working with dental patients as vigilant partners in promoting quality and safety. If properly engaged, dental patients are prepared to work with dental professionals to identify threats to safety and reduce the occurrence of harm.

Patient Safety Incidents in Primary Care Dentistry in England and Wales: A Mixed-Methods Study

BACKGROUND

In recent decades, there has been considerable international attention aimed at improving the safety of hospital care, and more recently, this attention has broadened to include primary medical care. In contrast, the safety profile of primary care dentistry remains poorly characterized.

OBJECTIVES

We aimed to describe the types of primary care dental patient safety incidents reported within a national incident reporting database and understand their contributory factors and consequences.

METHODS

We undertook a cross-sectional mixed-methods study, which involved analysis of a weighted randomized sample of the most severe incident reports from primary care dentistry submitted to England and Wales' National Reporting and Learning System. Drawing on a conceptual literature-derived model of patient safety threats that we previously developed, we developed coding frameworks to describe and conduct thematic analysis of free text incident reports and determine the relationship between incident types, contributory factors, and outcomes.

RESULTS

Of 2000 reports sampled, 1456 were eligible for analysis. Sixty types of incidents were identified and organized across preoperative (40.3%, n = 587), intraoperative (56.1%, n = 817), and postoperative (3.6%, n = 52) stages. The main sources of unsafe care were delays in treatment (344/1456, 23.6%), procedural errors (excluding wrong-tooth extraction) (227/1456; 15.6%), medication-related adverse incidents (161/1456, 11.1%), equipment failure (90/1456, 6.2%) and x-ray related errors (87/1456, 6.0%). Of all incidents that resulted in a harmful outcome (n = 77, 5.3%), more than half were due to wrong tooth extractions (37/77, 48.1%) mainly resulting from distraction of the dentist. As a result of this type of incident, 34 of the 37 patients (91.9%) examined required further unnecessary procedures.

CONCLUSIONS

Flaws in administrative processes need improvement because they are the main cause for patients experiencing delays in receiving treatment. Checklists and standardization of clinical procedures have the potential to reduce procedural errors and avoid overuse of services. Wrong-tooth extractions should be addressed through focused research initiatives and encouraging policy development to mandate learning from serious dental errors like never events.

Developing a Patient Safety Culture in Primary Dental Care

Patient safety should be at the heart of any healthcare service. Systems, teams, individuals and environments must work in tandem to strive for safety and quality. Research into patient safety in dentistry is still in the early stages. The vast majority of the research in this area has originated from the secondary care and academic fields. Approximately 95% of dental care is provided in the primary care sector. In this paper, we provide an overview of the evidence base for patient safety in dentistry and discuss the following aspects of patient safety: human factors; best practice; the second victim concept; potential for over-regulation and creating a patient safety culture. Through discussion of these concepts, we hope to provide the reader with the necessary tools to develop a patient safety culture in their practice.

Patient safety in dental care: an integrative review

Adverse events pose a serious problem for quality of healthcare. Dental practice is eminently invasive and involves close and routine contact with secretions; as such, it is potentially prone to the occurrence of adverse events. Various patient safety studies have been developed in the last two decades, but mostly in the hospital setting due to the organizational complexity, severity of the cases, and diversity and specificity of the procedures. The objective was to identify and explore studies on patient safety in Dentistry. An integrative literature review was performed in MEDLINE via PubMed, Scopus via Portal Capes, and the Regional Portal of the Virtual Health Library, using the terms patient safety and dentistry in English, Spanish, and Portuguese, starting in 2000. The research cycle in patient safety was used, as proposed by the World Health Organization to classify studies. We analyzed 91 articles. The most common adverse events were allergies, infections, diagnostic delay or failure, and technical error. Measures to mitigate the problem highlight the need to improve communications, encourage reporting, and search for tools to assist the management of care. The authors found a lack of studies on implementation and assessment of the impact of proposals for improvement. Dentistry has made progress in patient safety but still needs to transpose the results into practice, where efforts are crucial to prevent adverse events.

Dentists' practices and patient safety: A cross-sectional study

PURPOSE

To assess the frequency of dentist-reported practices to ensure patient safety in the dental office and the impact of training and work environment on this frequency using the framework of the International Patient Safety Goals (IPSGs).

METHODS

Dentists attending major conferences in Egypt and Saudi Arabia were recruited in a cross-sectional study in 2018. They completed a questionnaire assessing professional background and the frequency of practices for the IPSGs. The relationship between explanatory variables: training (postgraduate degrees and continuing education) and work environment (years in profession, working in public sector and performing surgical procedures) and the outcome variable: frequency of practices for 4 IPSGs was assessed using multivariate general linear model, and univariate general linear model was used to assess their relationship to the overall score of safety practices calculated for all goals.

RESULTS

The response rate was 81.1%. Practices related to reducing harm in the office environment were significantly less frequent than practices ensuring medication safety, ensuring safe surgery and controlling infection. The overall frequency of safety practices was significantly higher amongst senior than junior dentists. There were significant differences in safety practices frequency based on postgraduate degrees and receiving safety training. Dentists performing surgical procedures reported less frequent safety practices.

CONCLUSION

Practices to reduce harm because of the dental office environment were less frequent than other safety practices. Senior dentists, dentists who had postgraduate degrees and who received safety training reported more safety practices whilst those performing surgical procedures reported fewer safety practices.

Incident reporting in dentistry: Clinical supervisor's awareness, practice and perceived barriers

BACKGROUND

The significance of patient safety and risk management in dentistry has surfaced as dental settings bear delicate procedures carried out by teams utilising numerous devices and tools in complex environments.

AIM AND OBJECTIVES

Our aim is to assess awareness, practice, attitude and perceived barriers of reporting incidents amongst dental clinical supervisors working at dental colleges in Riyadh, Saudi Arabia. The objectives are as follows: (i) Determine if correlations exist between socio-demographic data and supervisors' awareness, practice, attitude and perceived barriers. (ii) Identify most common perceived barriers.

MATERIALS AND METHODS

An online questionnaire was sent to the 450 clinical supervisors working at five dental colleges of Riyadh. The collected data included items assessing the awareness, practice and attitude of reporting students' incidents along with the perceived barriers.

RESULTS

A response rate of (60.1% n = 264 of 450) was established. The majority of the respondents (62.9% n = 166) were aware of the incident reporting policy. Yet, only (35.4% n = 93) of them had completed an incident reporting form before. Most of the participants (90.5% n = 239) agreed on the necessity of reporting student's incidents, but only (67.0% n = 177) agreed on the necessity of reporting well-handled incidents. The possible negative relationship with students was the most agreed on barrier to reporting.

CONCLUSION

This study shows that certain demographics of supervisors had significant relationship with their awareness, attitude, perceived barriers and practice. Awareness of the policy and form was linked to the increase in supervisors' practice, although they tend to report verbally rather than in writing. The possible negative relationship with students was the most common perceived barrier.

Medico-Legal Considerations in Providing Emergency Dental Care in Practice

The unpredictability of unscheduled emergency dental care carries its own clinical, communication and management challenges with associated medico-legal risks. Providing emergency dental treatment for unfamiliar patients in an unfamiliar environment amplifies the hidden pitfalls which failure to avoid can create potentially damaging critical incidents in a practitioner's professional life. These are preferably avoided through consistent attention to best practice and risk management. Day to day processes, such as excellent record-keeping, valid consent and effective communication are under the spotlight in the event that a patient complains, raises a concern with a regulator or seeks compensation following alleged negligent care. This paper aims to highlight the dento-legal pitfalls that may be pertinent in such a challenging situation.