Attitudes of dental undergraduate students towards patient safety in a UK dental school

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.

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 Education in the Undergraduate Dental Curriculum: Evidence Base and Current Practice in UK Dental Schools

OBJECTIVES

International consensus advises patient safety education (PSE) for dental undergraduates. A previous systematic review found no articles describing PSE in dentistry. This article aimed to review the evidence base for, and the current practice of, PSE in UK dental schools.

METHODS

Literature search and surveys were sent via email to all 16 UK dental schools.

RESULTS

Six articles describing PSE interventions were found: 2 small-scale studies for dental students and 4 interprofessional studies. Patient safety education is effective for undergraduate dental students with significant improvement in knowledge and interest. Interprofessional studies reported improved teamwork skills and more positive attitudes toward interprofessional working.The 2018 and 2021 surveys had response rates of 56% and 100%, respectively. An increase in integrated formal PSE and assessment in UK dental schools is demonstrated. No barriers to implementation were reported. Forty-six percent of schools deliver interprofessional PSE, 38% deliver human factors, 81% teach communication, 94% teach professionalism, and 31% of schools have a patient safety (PS) champion.

CONCLUSIONS

Limited published literature on PSE in dentistry is available. However, the lack of published articles does not mean that PS is not being taught, as many UK dental schools were found to have formal PSE integrated and assessed within their curriculum. Further development is needed in terms of appointing PS champions for leadership and human factors training. Patient safety must form a part of an undergraduate student's core values.

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.

The impact of wrong-site surgery on dental undergraduate teaching: a survey of UK dental schools

INTRODUCTION

Patient safety within dental education is paramount. Wrong-site surgery (WSS) tooth extraction is not uncommon and is a significant never event (NE) in dentistry. This study aimed to explore dental schools' undergraduate experience of NEs, safety interventions implemented and the impact on student experience.

METHODS

All 16 UK dental schools were surveyed via email.

RESULTS

The response rate was 100%. A modified World Health Organization (WHO) checklist was used within institutions (94%) including pre-operative briefings and recording teeth on whiteboards (81%, respectively). Students were directly supervised performing extractions (63%) utilising a 1:4 staff: student ratio. WSS by students was reported in 69% of schools, with student experience being impacted by an increased patient safety focus.

DISCUSSION

This study demonstrated an increased utilisation of an adapted WHO checklist. Modification of practices to ensure patient safety was demonstrated at all schools, irrespective of student WSS occurrences. Institutions experiencing student NEs commonly implemented WHO checklists and recording teeth for extraction on whiteboards. Other strategies included direct staff supervision and pre-operative briefings.

CONCLUSION

UK dental schools have increased the emphasis on patient safety by the implementation of national healthcare models, for example WHO checklists and pre-operative briefings. These strategies both aim to improve communication and teamwork. Increased levels of staff supervision foster greater quality of teaching; however, this has resulted in reduced student clinical experience. A proposed minimum standard for undergraduate surgery is suggested to ensure safe and competent dental practitioners of the future.

Preventing Wrong Tooth Extraction

Objective of Work

Wrong-site tooth extraction (WSTE) is the most common serious patient safety incident in dentistry. Safety checklists have significantly reduced wrong-site surgery, although their benefit is unproven in primary care dentistry. Our quality improvement project developed and implemented a checklist optimised for oral surgery procedures in primary care to reduce WSTE risk.

Material and Methods

Local best practice for tooth extraction record-keeping (LBP), using national guidelines and standards was devised. We then retrospectively audited tooth extraction record-keeping against LBP. Deficiencies in current record-keeping practice were identified and used to design a checklist aimed at improving compliance. We provided a computerised safety checklist compliant with LBP to eleven clinicians at three general dental clinics within our region. The checklist included a pre-operative safety check, a pause to re-confirm the surgical site and a post-operative record-keeping proforma. The checklist was linked to our record-keeping software for use during tooth extraction. We audited checklist completion and compliance with LBP fortnightly for ten weeks.

Results

The introduction of a safety checklist resulted in increased compliance with LBP for tooth extraction record keeping. At week ten, 67% of records contained the computerised safety checklist. This resulted in a 50% increase in overall compliance with LBP for tooth extraction compared to baseline.

Conclusions

A computerised safety checklist for tooth extraction in primary care has potential to improve patient safety by adopting measures to prevent WSTE and standardising communication between clinicians. Checklists in general practice should be encouraged.

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.