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Patient safety in dentistry: Dental care risk management plan

Med Oral Patol Oral Cir Bucal. 2011 Sep 1;16 (6):e805-9. Patient safety in dentistry Journal section: Oral Surgery Publication Types: Research Patient safety in dentistry : Dental care risk management plan Bernardo Perea-P rez 1 Andr s Santiago-S ez 2, Fernando Garc a-Mar n 3, Elena Labajo-Gonz lez 4, Alfonso Villa-Vigil 5. 1. Director of the Spanish Observatory of safety for dentistry patients (OESPO). Professor of the School of Legal and Forensic Medicine of Madrid. School of Medicine. Universidad Complutense de Madrid 2. Member of the Spanish Observatory of safety for dentistry patients (OESPO). Professor of the School of Legal and Forensic Medicine of Madrid. School of Medicine. Universidad Complutense de Madrid 3. Member of the Spanish Observatory of safety for dentistry patients (OESPO). Member of the Board of Directors of the Spanish Society for Oral and Maxillofacial Surgery (SECOM). 4. Member of the Spanish Observatory of safety for dentistry patients (OESPO).

Med Oral Patol Oral Cir Bucal. 2011 Sep 1;16 (6):e805-9. Patient safety in dentistry

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Transcription of Patient safety in dentistry: Dental care risk management plan

1 Med Oral Patol Oral Cir Bucal. 2011 Sep 1;16 (6):e805-9. Patient safety in dentistry Journal section: Oral Surgery Publication Types: Research Patient safety in dentistry : Dental care risk management plan Bernardo Perea-P rez 1 Andr s Santiago-S ez 2, Fernando Garc a-Mar n 3, Elena Labajo-Gonz lez 4, Alfonso Villa-Vigil 5. 1. Director of the Spanish Observatory of safety for dentistry patients (OESPO). Professor of the School of Legal and Forensic Medicine of Madrid. School of Medicine. Universidad Complutense de Madrid 2. Member of the Spanish Observatory of safety for dentistry patients (OESPO). Professor of the School of Legal and Forensic Medicine of Madrid. School of Medicine. Universidad Complutense de Madrid 3. Member of the Spanish Observatory of safety for dentistry patients (OESPO). Member of the Board of Directors of the Spanish Society for Oral and Maxillofacial Surgery (SECOM). 4. Member of the Spanish Observatory of safety for dentistry patients (OESPO).

2 Professor of the School of Legal and Forensic Medicine of Madrid. School of Medicine. Universidad Complutense de Madrid 5. President of the General Board of Dentists of Spain Correspondence: Escuela Medicina Legal y Forense de Madrid, Facultad de Medicina. Pabell n 7, Avda. Complutense s/n, Perea-P rez B, Santiago-S ez A, Garc a-Mar n F, Labajo-Gonz lez E, 28040. Madrid, Spain. Villa-Vigil A. Patient safety in dentistry : Dental care risk management plan . Med Oral Patol Oral Cir Bucal. 2011 Sep 1;16 (6):e805-9. Article Number: 17085 Medicina Oral S. L. B 96689336 - pISSN 1698-4447 - eISSN: 1698-6946. Received: 04/05/2010 eMail: Accepted: 06/09/2010 Indexed in: Science Citation Index Expanded Journal Citation Reports Index Medicus, MEDLINE, PubMed Scopus, Embase and Emcare Indice M dico Espa ol Abstract Objectives: Although the safety of patients has been one of the inherent concerns of Dental practice, but because the proposals made in the field of dentistry are few and improperly structured, this paper constitutes an attempt to present a proposal titled plan for Dental Health Care Risk management , promoted by the General Council of Dentists of Spain, including a description of the proposed work methodology.

3 Design: The risk management plan proposed in this paper is based on applying the basic concepts dealt with in Patient safety to the field of dentistry , due to the fact that the available bibliography contains no specific health care risk management plan for dentistry specifically. Results and conclusions: In order to implement health care risk management in the field of Dental care provided at any level throughout Spain, a seven-step plan which covers the main objectives in Patient safety is provided. Key words: Adverse events, error, clinical risk management , Patient safety , oral surgery. Introduction of Health Care in America of the Institute of Medicine, Patient safety has become one of the focal points of achieving safe health care practices became a top priori- health care in recent years. Though the concern for not ty for health care authorities. At present, there are many harming patients (the Hippocratic primum non noce- institutions which have developed programs and initia- re ) has been a fundamental factor in health care since tives to improve Patient safety (1-3).

4 One representative it first began, as of the publication in 1999 of the study example would be the World Alliance for the safety of titled To err is human by the Committee on Quality patients promoted by the World Health Organization e805. Med Oral Patol Oral Cir Bucal. 2011 Sep 1;16 (6):e805-9. Patient safety in dentistry (WHO) (4) or the Luxembourg Declaration of the Eu- - Definitions. ropean Union (5). The following definitions are provided by the ICPS. Within the field of dentistry , the proposals have not (International Patient safety Classification) proposed been as numerous or as structured. Although Patient by the World Alliance for Patient safety of the World safety has also been one of the inherent concerns in Health Organization (WHO) (11). Dental practice, and alerts and recommendations have 1. Patient safety . been given out on pharmaceutical products, Dental ma- Patient safety means a decrease in (or elimination of, to terials and clinical procedures, the programs organized the greatest extent possible) the harm to patients caused specifically for promoting Patient safety have been few by treatments provided, or from accidents associated (6-10).

5 At the same time, there is little structured or well- with those treatments. studied data regarding adverse events in dentistry . The 2. Risk management . existing bibliography describes isolated clinical cases This is the attempt to identify, evaluate and deal with or short series on the basis of which empirical clinical problems which may cause harm to patients , to file recommendations are made. complaints about malpractice and to avoid unnecessary There are reasons which explain this delay in dentistry economic losses for health care providers. when compared with most other health care professions: 3. Adverse Event. - The harm produced is generally less severe. Unexpected result of a health care treatment which - The patients are ambulatory (this makes it difficult to be- leads to prolonging treatment, some type of morbidity, come aware of and follow up on many adverse events). mortality or simply any harm which the Patient should - There is a great dispersion of Dental care which makes not have suffered (12).

6 It difficult to collect data. It is a broad concept which includes errors, accidents, - Dental care is fundamentally private, and the fear may delays in providing care, negligence, etc., but not the exist that reporting adverse events might have some re- complications inherent to the Patient 's disorder or di- percussion on the commercial profits of clinics. sease itself. - There is not a generalized culture which deals with 4. Error. Patient safety . The motivations are different for profes- Mistake due to action or omission in health care prac- sionals, and the potential for undertaking educational tice, whether an error of planning or an error of execu- campaigns that reach all dentists is limited due to their tion (13). The error may or may not lead to the existence widespread dispersion. of an adverse event. Nevertheless, there are many reasons why we believe 5. Near miss. that dentistry must become more active in dealing with Event which nearly causes harm to the Patient and which everything involved in Patient safety .

7 Among these rea- is avoided by luck or due to action at the last moment sons is the fact that we handle potentially dangerous (14). One example would be prescribing an antibiotic pharmaceuticals (by themselves or as a result of their derived from penicillin to an allergic Patient , because interactions), Dental procedures are becoming more this information does not appear in his or her clinical re- aggressive (especially the surgical techniques related cord, and gaining knowledge of that allergy because the with implantology), we deal with technical instruments Patient informs us of it when we provide him or her with (ionizing radiation, lasers, etc.) which may be harmful, the prescription. Various studies have found that many and the contact of our instruments with the blood and more such incidents (near miss) occur than do actual ad- bodily fluids of patients may constitute potential sour- verse events. In the specific case of prescribing pharma- ces for the transmission of diseases.

8 Ceuticals, it is estimated that approximately seven times Due to all of the above, we believe that Dental practice more near misses occur than adverse events (15). must more actively become involved in the international 6. Accident. trend towards Patient safety . It is with this goal in mind that Random, unforeseen and unexpected event which the General Council of Dentists of Spain has promoted the causes harm to the Patient or any other type of harm plan for Prevention of Health Care Risks in dentistry . (material damage, harm to health care personnel, etc.). The objective of this article is to explain the goals of this 7. Negligence. plan , as well as its organization and work methodology. Error which is difficult to justify due to a lack of knowl- edge or basic skills, failure to take minimum precau- Materials and Methods tions, carelessness, etc. (16). No available bibliography exists regarding any plan for - Professional error in dentistry . health care risk management specific to dentistry .

9 Be- The literature on error in medicine is extensive, espe- cause of this, the risk management plan proposed in cially in terms of adverse drug events, errors in pres- this paper is based on applying the basic concepts dealt cription and medication errors, and errors in Intensive with in Patient safety to the field of dentistry . Care Units, trauma care or anesthesia (17-19). However, e806. Med Oral Patol Oral Cir Bucal. 2011 Sep 1;16 (6):e805-9. Patient safety in dentistry there are hardly any studies dealing with the frequency In order to be able to achieve the plan 's general objec- and effects of the errors committed in Dental practices. tive, the following specific goals have been established: This may be due to the limited repercussion on Patient 1. To promote a Culture of Patient safety in Dental health which they tend to have, as well as the great dis- care. persion of clinical records, which makes any investiga- The culture of safety was defined by the ACSNI (Advi- tion quite difficult.)

10 Sory Committee on the safety of Nuclear Installations): The errors in Dental care may be of a human origin (in An organization's culture of safety is the product of in- which a professional reaches an erroneous decision or dividual and group values, attitudes, perceptions, skills provides a deficient treatment), but in most cases their and patterns of behavior which lead to commitment, occurrence is to a great degree dependent upon many style and ability in the management of the health and contributing factors related with the system, which lead safety of an organization. Those organizations with a to a chain of errors and end up causing harm to the pa- positive safety culture are characterized by communi- tient (20). cation based on mutual trust, by shared perceptions of - Oral surgery and Patient safety . the importance of safety and by trust in the effective- Within the realm of health care, all of the research points ness of measures for prevention.. out as the causes of the largest number of adverse events 2.


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