About Glenda Farmer

Leading innovative Smartdentist to provide online dental practice accreditation and infection control solutions for SMART dentists and practice managers

Tracking and Tracing – What is the difference?

Do the terms “tracking”, “tracing”, “traceability” and “batch control identification” confuse you? You are not alone. Even the experts have trouble agreeing on what these terms mean. Because we use these terms in relation to reprocessing (sterilisation) of Reusable Medical Devices (RMD) in dentistry and medicine, it is very important that we have a clear idea about their purpose.

Where do the terms come from?
The terms tracking and tracing have logistical origins.
Tracking is a process where you know where any item is at any time.
Tracing is being able to tell the history of where an item has been.

Why does it matter?
1. In the event of a failure in your reprocessing system you need to know how to do a recall of instruments (tracking) or recall of patients who were exposed to those instrument (tracing).
2. In the event of a patient acquiring an infection only attributed to their healthcare experience/treatment (HAI) then it is important to be able to determine whether reprocessing of RMD (tracing) played a part in the HAI.
[3. Accreditation requires these processes are in place because they are important aspects of safety and quality systems.]

Why is the confusion with terms?

Dentists traditional are more familiar with the term “batch control number” or “batch control indentification (BCI)” (AS 4815:2006). Using BCI, RMD are linked to a sterilization cycle batch (tracking) and if the RMD are used, then traced to a patient.

In newer AS/NZS 4187:2014 and National Standards (used in accreditation) the term “Traceability” is used instead of “tracking and tracing” or Batch Control identification. This is because traceability is no longer just concerned to items going through a steriliser “batch“, but include any RMD’s reprocessed in high level chemical disinfection system. Batch Control Identification is just considered a version of “traceability”.

Unfortuately ADA Guidelines for Infection Control (Third Edition) 2015 says that traceability has no place in dental practice!

What!
Don’t misinterpret this statement.

The ADA guidelines make that statement about “traceability” ONLY because the ADA guidelines authors took a very specific view/interpretation of the meaning of  “traceability”.  In fact the ADA Guidelines fully supports the use of BCI, which is the form of traceability required by the standards for general dental practice.
The version of  ‘Traceability‘ which is considered unnecessary by the ADA in dentistry involves high levels of instrument identification and high levels of tracing history. e.g. being able to trace individual instruments (laser or otherwise uniquely identified) each time they are used on patients and then each time they are reprocessed. Imagine the pointless data bloat if we traced the history of patient use and sterilisation cycles for each identifiable individual instrument, over a compulsory 7 year period. e.g. 10 instruments in your cons kit X 3 sterilisations per day X 3 patients treatment X 5 days per wk X 52 wks per year X each 7 years = 163800 individual records for one cons kit.

How traceable does traceability need to be?

“As a minimum, the traceability system shall be sufficient to enable the identification of a patient(s) where a nonconforming product has been used in an event that a recall is necessary.” [AS/NZS 4187:2014]
Procedures need to be in place to detect a nonconforming product before they are used on a patient.

A. What needs to be traced when we reprocess a RMD?

AS 4815:2006 AS 4187:2014 ADA Guidelines RACGP Standards!
Patient R R R O
Steriliser Batch R R R O
Semi-critical# RMD  R^
Critical# RMD R R* R O
R – Required
O- Optional but recommended
* Individually identifiable RMD if implantable and reprocessed
^ If undergoing high level chemical disinfection
# Semi-critical RMD are those that come into contact with mucous membranes or non-intact skin.
# Critical RMD are those that come into contact with the vascular system or sterile tissue and that shall be sterile at the time of use. e.g. surgical instruments.
! RACGP Standards for General Practice July 2017 (medical drs)

B. Where is the Traceability information recorded?
The Traceability system forms part of the release and quality assurance management of RMD. The system of traceability could vary depending on whether an electronic system or paper system is used.

Where to start

Any healthcare organisation who packages instruments can set up an extremely simple system for traceability and quality control.
A. Sterilisation log
All practices are required to keep a sterilisation log book. This can be a paper book; a paper log that is scanned into a computer; or an electronic logging system. The record requirements are the same in each case (see table). Each sterilisation load has a separate sterilisation load (or batch) number. This load number must be unique especially if you have more than one steriliser.
B. Recording information on the packaging of RMD’s
By recording the sterilisation cycle + date we have a link back to all the respective data on the sterilisation log for that cycle. The date helps us use the oldest pack first and if necessary an expiry date. The packaging staff member initals the pack so if the pack instruments are incorrect or nonconforming (not clean) then we can consult; educate and correct this process. The external chemical indicator allows the end user (dental practitioner) to check themselves as to whether the instruments went through the steriliser. The stage of examining and opening the package is a “release” phase in reprocessing and would be the responsibility of the operater or assistant.
(Est time to do this. 2 second with a self inking date and cycle stamp – cost $110 for 1000’s of prints)
C. Patient records
The steriliser cycle number is added into the patients records which will already include a date. This cycle information allows us to find the patient should a future recall of instruments from that particular sterilisation cycle occurs.
Time to do this: 2 seconds.

Packages of RMD Steriliser Log Patient Record
Cycle Number Cycle Number (unique) Cycle Number
Date processed Date processed Date of use
Packing person Load and release person/s
Contents * if not obvious due to packaging Contents of load: RMD name or set and number
Chemical indicator Parameters printout
Functional tests e.g. Bowie Dick/Helix

Traceability can be simple or complex. You can trace each load or only critical instruments. The best, quickest and easiest system is one that is consistent for all instruments and staff at the practice.

References:
Guidelines for Infection Control 2015 Australian Dental Association
RACGP Standards for General Practice Jul 2017

dental equipment needs sterilising

 

 

Oasis software Banking reconciliation

Lining up your daily bank feed with daily practice payments is an easy task if you understand the basics. Bank reconciliation should be done each day so errors are picked up and investigated straight away. With bank feeds via MYOB or XERO this should be a quick task which takes no more than 2 minutes.
Regular reconciliation makes end of month calculations a simple quick task.

1. Send all your income to the one bank account and set up another account for payments. This makes it clean and easy to see. (If this is not your current practice then set up the second account for payments and leave your income coming into your existing account.)

2. Print off a bank statement and look at the entries. Become familiar with how and when you are paid. The following relates to NAB but will be similar for any bank. These are the credit entries in my online bank transaction area in NAB:
2.1 Deposits – this is our total of cash + cheques together. If these are banked daily life is easier. (Banking of cash and cheques is done the day following the payment.)
2.2 Eftpos – this is banked daily via our hicaps terminal which settles at 8.45 pm each night and is banked on the day they are processed at our practice (Practices can manually select to “settle” if they want a different time.). Note: refunds are not processed until the following day and are separate to credits.
2.3 Hicaps – this is banked the day AFTER they are claimed by our practice. If a reversal is made then this is included in that days’ claims. Claims made after about 9pm may not appear until the day after.
2.4 DVA – Vet Affairs are claimed online by our staff and are paid in 1-2 days usually. The bank entry will have the provider number in the bank entry. The totals are somewhat unpredictable but always just for a single dentists. Once paid the statements can be accessed from the HPOS or PRODA accounts.
2.5 CDBS – This is paid per practitioner and will be paid 2 hrs to 2 days. Usually the next day. The bank entry will have the provider number in the bank entry. Payment or refusal reports are available at HPOS or PRODA accounts.

3. Oasis software – Closing off of banking
Closing off of banking is a process undertaken by reception. It clears off that part of banking and payments which is considered correct and “finished with”.

[Learn how to “keep” and “release” banking in Oasis – you can do this for individual transactions and for whole pages of transactions. You can also set a default for each type of banking. Learn how to only view certain types of banking in Oasis e.g. find only cash and cheques.]

3.1 Deposits – Cash and cheques are “released” and closed off each end of day (Oasis task). The money and cheques are put in a deposit slip/envelope and our petty cash is counted to make sure no errors have occurred. A deposit slip is printed.
The deposits are checked the next morning and then taken to the bank and deposited with a teller. This is done via tellers because we got tired of disputed amounts when we placed money in “night banking”. Our staff need to be accurate when they are standing with a teller! Daily banking helps with reconciling Oasis and the bank. If you banked less frequently you would NOT close this off until you were ready to bank it.
3.2 Eftpos – This is closed off with Cash and Cheques at the end of the day. If a reversal has occurred during the day this MUST be released and closed off separately. Staff are NOT permitted to do a reversal except on the day it occurred. e.g. they can not have the HICAPS password.
3.3 HICAPS – This is closed off the next day. (first thing before we start with patients). Staff go onto the HICAPS website and print off the relevant days transactions and compare it to our HICAPS total and if it is the same the HICAPS is released and closed off.
3.4 DVA – any invoices to Veteran Affairs are held in the Marked Payment area of the Veterans Affairs account in Oasis. As the payment appears on the bank feed the payment is marked off as a DirectDebit. This direct debit can then be closed off as a distinct payment.
3.5 CBDS – These payments appear in the Oasis banking screen for Eclaims but are always placed on KEEP until they appear in our bank feeds as paid. As long as CDBS payments are NOT released from Oasis they can be altered. e.g. if they don’t get paid we can alter then and then they do not appear as incorrect on individual dentists monthly summaries.
As CDBS payments appear on our bank feeds they are “released” and closed off. Closed off totals must match a bank feed entry. i.e. Dr X get paid $240 from CDBS in one bank entry and Dr X gets paid $47 in another bank entry. Each of the bank entry totals are closed off separately so $240 is closed off, then $47 is closed off. This way we can relate each bank entry with a Oasis close off.

After the HICAPS close off each morning staff also print off the Daily Oasis Bank summary for the previous day and this is used for bank reconciliation. Except for Cash and Cheques (totaled together), each figure is entered as a separate sales amount in MYOB and it will be matched with a separate bank feed entry.  (takes about 2 minutes. Remember to put them in as Paid Sales or the bank feed in MYOB wont find them)
Easy.

 

Dental Equipment Register and Maintenance Recording

You don’t need a Dental Equipment Register if you can remember the date of each purchase and the cost!
You don’t need maintenance recording if nothing ever breaks down!
I, however, do not remember the make and model of my dental chair, nor the reason we last had it fixed (so many reasons to remember) so I developed a solution. Yes and my solution has been improving.

Check out how Dental Equipment Register works for my practice in the latest youtube video. If you have an asset register in MYOB or Xero and want to use it so start off in SmartDentist please let me know. The accounting package asset registers lack the detail you need to call and get something fixed and they don’t have the ability to keep track of the repairs and maintenance to equipment. If you are using Simplified Small Business Depreciation you might even find you don’t have much of an Assets register at all!

Try out the SmartDentist’s Asset register for your dental practice today!

Both our small and big equipment are high costs for the practice. We don’t want to keep paying for the same sort of repair and we need to know whether a piece of equipment is close to its used by date before we pay for expensive repairs.
The SmartDentist.com.au Equipment Register and Maintenance recording gives practitioners a level of control and understanding that has not been available before now to the small business owner.

Flu shots and immunisation for dental staff

Time for Flu shots and immunisation checks for dental staff

Get the flu shot immunisation today

It’s never too late to vaccinate/ immunisation for health

There is nothing that bonds all the dental team together better than having your flu shots at work!

Why now?
April is the ideal time to arrange your flu shots. The peak season for flu is late July August so having the flu shot now means you will build up immunity by the time the risk of catching the flu is greatest.
Flu vaccinations are one of the recommended vaccinations for healthcare workers (or anyone in contact with the public!)

Immunisation for Dental Staff

The ADA’s latest News Bulletin outlined the requirements for Dental Staff immunisation. SmartDentist subscribers have an easy way to meet staff immunisation obligations. To find out more you and your staff can do an online training course on the flu and your immunisation obligations. This will earn you CPD points as well!
Dental practices with accreditation need to fulfil staff training obligations so encourage each staff member to learn and join in the conversation about immunisation, the flu and infection control.

SmartDentist is the easy solution to fulfilling all your immunisation requirements with:

  • a practice policy that includes management of staff refusal;
  • employee and pre-employment immunisation forms;
  • an immunisation register;
  • information for staff on vaccine preventable diseases

Mandatory immunisation of healthcare workers

Queensland Health now require job applicants for dental roles to supply evidence of vaccination or evidence that they are not susceptible to prescribed vaccine preventable diseases.

Dental practices would be wise to follow the lead of Queensland health and use their pre-employment forms and their evidence criteria (all available online).
SmartDentist has pre-employment forms and recommends dental practice adopt this vaccination requirement for new staff. It helps streamline the practices obligations and reduces stress if a sharps injury occurs.

PRODA set up for Dentists made easy with SmartDentist | CDBS | DVA payments

PRODA (Provider Digital Access) for the dental practice

Now you will need a PRODA login* to claim payment immediately for Child Dental Benefits Schedule and Veteran’s Affairs. Online claiming is easy and brings enhanced cash flow to your dental practice. At our practice all our receptionists have become familiar with HPOS, checking out CDBS eligibility and claiming payments straight away from the government.
[Go to the Dept of Human Services web site now to find out more]

SmartDentist is helping dental practice get their the new PRODA system up and running.
Record your PRODA ID in your staff profile on Smartdentist AND Smartdentist  creates a PRODA ID list that can be printed or emailed so people can easily ‘delegate’ to each other. This is a great place to keep these details and as staff come and go you don’t have to try and remember where you placed your PRODA ID.

SmartDentist Staff Profile also allows you to record an additional email address.
We use this additional email address for the PRODA 2 step verification (so reception staff don’t need their mobile phones or to access their home email while working at reception). The SmartDentist Staff profile allows me to let the staff know what email address they should setup for their PRODA login.

Creating individual staff emails using your domain name (email aliases)
For those practice managers unfamiliar with creating an “email alias” you can actually have glenda@yourpractice.com.au, jan@yourpractice.com.au, and cat@yourpractice.com.au all as email aliases for admin@yourpractice.com.au. e.g multiple email names for the same email address.
Depending on your email system it may cost up to $7 per user per month for additional emails, but not if you are using an email alias!

*PRODA login for the HPOS on the Dept of Human Services site is not compulsory yet but the USB connections for our reception computers have been damaged by “USB stick in – USB stick out” and we want our system up and running BEFORE they close down the PKI certificates.

End of month -online marketing and advertising

End-of-month bookkeeping is a way of life for most of us running a dental practice. What about also having an end-of-month reconciliation of your online presence?
Save money, worry and time by checking your own online presence, marketing, advertising, and SEO free with free Google tools. Would that be too hard? No and someone on your staff would love to do this. Don’t they love playing on the internet!
SmartDentist wants to help you do this easily.
Check out our newest policy on SmartDentist
End of month: Online Marketing and advertising
With links and a checklist of your online presence, this policy helps dental practices to gather together all their online marketing details they need to ensure the practices online presence stays relevant, effective and up-to-date.
Online marketing details?
Did you know Google and Bing provide a range of free tools that are used by SEO and marketers to keep track of your online marketing. Yes – they are free!
The policy allows you to gather the details for these in the one place and gives simple lists of tasks to keep your website and social media presence working well. For each of the Google tools you simply need to register. So once you have registered to use these tools you will need somewhere to note where you store your username and password. e.g. these are your online marketing details!
If you have ever wondered or worried after being approached about your inadequate google ranking? Have you had visits from sales people wanting to help boost our Google Local Business listing?
You can pay someone to review these FREE TOOLS and report their finding back to you. You can pay someone to remind you to pay them to add a photo on your Google Local Page listing…or
use this new policy with lists and links and free tools (all together on one page) so you can actually check out what is happening in your online life. The policy also gives you lists of easy tasks to keep your online presence working for you.

Policy task example
Google MyBusiness Task:

  • Add a new photo each month to your Google Local Business listing.
    [ Do your staff all have an iPhone/android phone at work? Why not have a photo competition for your Google Local Business photo needs.]

Do you have a practice facebook page?
Then use this “End of Month” policy to remind you to “share” information into your facebook presence. Need ideas of what to share? The policy includes websites which should provide you with a new share idea each month.

Marketing and My own practice website

Two years ago Google announce that having a https site was a ranking signal

…and we all want to rank well with Google!

While the change doesn’t make that much sense for dental practice sites I decided that I would update my practice website from http to https. (Read about Google search and https)
For localdentist websites, my site is the “crash-test-dummy”.
Along with making my site into a https site I have made “under the boot” SEO changes.
Below are the changes I have just recently made to my site.

  1. https – This is a cost change because of the need to purchase an SSL certificate. This is a yearly extra cost.
  2. Structured data added. See the lowest part of my website with details such as open hours etc. This has been setup with special data coding. Google recommends this coding and may utilise it in page rankings someday. Read more… You wont see the extent of these changes unless you used the developer tools on your web browser and look at the source code of the page.
  3. Facebook share and follow links – allowing practices to easily “share” the monthly website updates into their other social media such as Facebook.
    Recent pages have a facebook share friendly image for excellent presentation.
  4. Increased Search engine friendly links to the extensive range of Localdentist pages. Practices can now just let me know if they want individual pages removed or replaced with their own content.

If you have a “localdentist” websites then these changes will be integrated into your site over time(except https). If you would like to change your site to https like mine please contact me.
For subscribers who do their own website or have a wordpress site I am happy to help or provide training.
SmartDentist users – happy to help with your end of month marketing updates!

Online presence

Facts and Myths Infection Control

infection control myths and facts

Facts and Myths of infection control (heard or read in 2016)

  1. Via “tracking” you can demonstrate a patient hasn’t got an infection from your practice (controlling infection control!)
  2. An ultrasonic is needed even if you have a washer-disinfector.
  3. It’s quicker to ask the ADA than seek the answer yourself.
  4. No-one has ever got an infection from a dental practice.
  5. Ever Sterilisation cycle needs a PCD (Helix or Bowie Dick)
  6. An ICMP (infection control management plan) replaces your sterilisation manual.

Let’s look at the statements –
1. Tracking instruments
Tracking is required to keep dentists and their staff “on the ball”. Tracking tries to demonstrate that a particular pack of instruments has been through a particular steriliser cycle. BUT unless your tracking system takes a picture of the pack with the steriliser tape color changed you aren’t even really demonstrating the pack went through a cycle!
Most systems only tell you that you know the number of a cycle that has been completed.

However that doesn’t mean I disagree with tracking. We track all our instruments because I think it is good idea. However personally I would be cautious about investing a lot of money into a scanning tracker system at this stage because I think they will improve in the future. I imagine a time when the scanner picks up the changes in the packaging that occur with sterilisation rather than just reading a bar code that remains unchanged in the steriliser.

Of course sterilisation is a theoretical practice. When we sterilise we do so with an assurance that the possiblity instruments have one viable bacteria on them is one item in one million. However we know that if instruments are not cleaned properly then this figure is incorrect and people have been infected via instruments that have been through sterilisers (not dental instruments) at correct time, temperature and pressure.
If stats were taken literally:
21,000 dentists in Australia  X 48 sterilisation cycles = 1 million cycles
So does that mean that you never want to be the 49th patient a dentist sees because you are likely to have THE VIABLE micro-organism!
Nahhh… but it isn’t that simple.

Track all your instruments for convenience because simple systems are the quickest and the best.

2. Ultrasonic Cleaners
Ultrasonic cleaners were basically introduced for staff occupational health and safety (safe non-scrubbing). They are designed to reduce operator error in instrument cleaning. However in dentistry we all know that unless you remove composite and cements from instruments immediately chairside then an ultrasonic cleaner nor a washer-disinfector are not going to work.
Washer-disinfectors are used similarly to ultrasonics in dental practices so generally if you use one then you dont need the other. You should speak to other dentists who use washer-disinfectors or ultrasonics when you are looking to buy a new one. Some washer-disinfectors have an ultrasonic mechanism built in.

Testing ultrasonic cleaners each morning is for the benefit of the practice. It is of no use placing instruments into an ultrasonic cleaner that is not working!!!
Also remember that research has shown if you place instruments into dirty ultrasonic cleaning liquid they will be dirtier than when you put them in.

3. ADA versus Google
It’s always nice to speak to a person at the ADA but for many issues it is quicker googling and asking the source. Examples: Fair Work – look up the staff award and read it yourself. You are supposed to have an award accessible for the staff anyway; Long Service leave – this is a state based function and Victoria has a really helpful help line.
The ADA committee members have a wealth of knowledge but you need to allow time to get onto the correct person.
Other options of information:
Generally some of the facebook groups for dentistry are interesting for different opinions and you can often get a quick response as dentists play online. The ADA Inc site has helpful HR resources but check that they are current and applies to your own state.

Remember the ADA in Australia is a professional group of dentists and have no power to set “rules”. Even the ADA infection control guidelines can be seen as an “interpretation” of AS 4815 and the NHMRC guidelines. The Dental Board resources should be looked at first for clinical advice. The Oral Therapeutic Guidelines are also important for conventional requirements. The ADA has representatives on the Therapeutic Guidelines Committees and on Standards Australia committees.
For SmartDentist subscribers check out your “Clinical Guidelines” [Resources > Clinical Guidelines] first as this is a group of documents to help you make effective clinical decisions.

4. No-one has ever got an infection from a dental practice (other than the contriversial HIV dentist)
This is not correct. There have been documented cases of infection transfer.
The recent 4 cases of Infection control breaches in 4  NSW practices has had a review and they know 26 people from the practices have now newly discovered they have BBV.
http://www.health.nsw.gov.au/Infectious/reports/Documents/dental-investigation-report-2016.pdf
Check out this most recent review on dental transmission.
https://www.cdc.gov/oralhealth/infectioncontrol/pdf/pathogentransmission.pdf

5. Every sterilisation cycle needs a PCD
Helix or Bowie Dick devices are required at the start of each day for an empty steriliser. They aim to “challenge” a Process – hence the name Process Challenge Devices. The process they “challenge” is the ability of the steriliser to remove all air from the steriliser so it can fill up totally with steam. You can use a specific device made to test this in your normal cycles but these tend to be slightly different in nature. While this is heavily promoted by a particular supplier of these consumables (yes, they sell them) the evidence for their use has not been declared manditory by AS 4815.
The requirement by Australian Standards is to have the device used at the start of the day.

6. An ICMP (infection control management plan) replaces your sterilisation manual.
No your sterilisation policy manual is only part of the infection control management plan. The idea of a “management plan” is that you:

  1. Work out what you need to manage.e.g. what are your infection control risks? Name and sham each one of them. Use a Risk analysis tool to document the risks and have them in your risk register so you can review them at a later date.
  2. Document how you are managing these infection control risks. e.g. this is via your policies and procedures so this is where your infection control manual fits in. You cant just use the ADA guidelines as that document isn’t a procedure manual and says in some parts…”you can do this….or you can do that”.
  3. Plan staff training so everyone is part of implementing your plan

SmartDentist subscribers have an online Infection control management plan – easy!

ICMP for Dentists

Infection Control Management Plan Qld Dentists
Are you a dentist in Queensland?
Do you understand your practice is required to have an Infection Control Management Plan (ICMP)?

The DBA Meeting in March 2016 reports that the Chief Health Officer of Queensland’s Department of Health asked the Board to make practitioners aware of the requirement under the Public Health Act 2005 (Qld) for all dental practices (private and public) to have an Infection Control Management Plan.
Interestingly this has been a requirement since Dec 2006 but just recently the Health Department has decided to randomly audit dental practices.

SmartDentist makes the process of developing an ICMP easy. We have templated policies covering the 10 core elements of a ICMP. SmartDentist also has templated the core risk assessment  requirements and provides a simple means to provide online training and the timetabling and recording of training.
The solutions within SmartDentist provides the means for keeping your ICMP a ‘living’ part of your dental practice. Incident reporting and auditing, via Smartdentist, supplement the way the ICMP actually works within a practice.

The Qld Health Department doesn’t recognise the ‘introduction to Dental Practice Accreditation’ as evidence of compliance but the elements of an ICMP should be covered when practices complete accreditation against the NSQHS standards. Your dental practice accreditation should have included infection control policies covering the 10 Core Elements of an ICMP; Register of IC risks and Staff training.

View a completed Infection Control Management Plan
This youtube video demonstrates the ICMP within SmartDentist and how the process of bringing together the core aspects of your Infection Control Management Plan is made manageable with the solutions in SmartDentist.

Dental Practices can either chose a solution for their ICMP which repects the need for ongoing review and compliance with infection control or just worry about a temporary paper chase when the Health Department contacts them.
For help in creating a management solution or any aspect of your ICMP contact me directly glenda@smartdentist.com.au or join SmartDentist today.

PS. Check your own policies against these infection control elements.
The ten core elements in an ICMP are:

  1. Hand washing and hand hygiene
  2. Personal protective equipment
  3. Management of blood/body fluid exposures
  4. Infection control and employee health
  5. Immunisation
  6. Environmental hygiene
  7. Pre-treatment assessment of infection control risk
  8. Non-reuse of single-use medical devices and reprocessing of reusable medical devices
  9. Delegation of responsibility for infection control
  10. Process for the investigation of infection control incidents

practice validation and the ADA

Have you read the ADA News Bulletin Aug 2016- Practice Validation and infection control
Glazed eyes? Confused? Yes infection control is an unromantic topic.
Here is my attempt in trying to explain what the author might have meant by “Practice validation and infection control” –

In your dental practice you need to consider what you do about infection control because it has to be:

  1. as required by law
  2. written down (computer is ok)
  3. what staff actually do

Your procedures must include the collection and saving (storing) of some physical evidence that staff have actually done what they are supposed to do in particular areas of procedures.

The topics you need to cover with written procedures may best be sourced from the list in “The ADA guidelines for infection control”. The ADA Guidelines list was the basis for SmartDentist template procedures. You can use these as for your own procedure manual (e.g. Go to the template library and press +add. Then change as required)
The Accreditation standard 3, quoted in the article as a reference source for appropriate policies and procedures, does not ONLY cover infection control but includes preventing infections – hence the confusing inclusion of antimicrobial prescribing etc. (check out SmartDentist for policies and procedures in these additional accrediation areas)

The ADA News Bulletin article goes on with detailed information specific to the validation of autoclaves (moist heat sterilisers).
[I wonder if this is because I have recently seen sales info. that says you can buy a sterliser that comes supplied with a validation certificate! That is a big no no! (except if you are in a remote area)]

For practices that think they need to conform to AS/NZ 4187 be warned that the information in this article falls well short of the requirements for validation in AS/NZ 4187 but most of us will use AS4815 as discussed in the article.

It seems a bit odd for the ADA to state in writing (for others to quote later) that it is the dentist’s responsibility that steriliser validation is properly conducted. It is a bit onerous to need to be the expert instead of the technician.
Instead here is a quick checklist for you to pick a suitable technician:

  1. Do they also service and repair sterilisers?
  2. Do they provide a validation certificate and records?
  3. Will they remind you when validation is due again?
  4. Do they require staff to supply a range of “usual packs” of instruments?
  5. Do they require biological indicators to be incubated over time so they DO NOT provide immediate certification?

Rather than push responsibility back to the dentist for being a steriliser technician the ADA could consider an “ADA approval” process for those who service and do validation on office based sterilisers.

New to SmartDentist: You can upload your validation certificate into SmartDentist.

HOW TO SAVE YOUR VALIDATION CERTIFICATE:

  1. Add your Steriliser to Equipment Register
  2. Set up a Service timetable
  3. When the service is due and completed upload the validation certificate and the service timetable will re-date to the next service time.

EOFY and Dental Accounting

In July 2015 I took over the accounting at our practice. As you can imagine I delved in deep and set up new systems for efficiency. Here is what I have learnt in the past 12 months.

BANKING

  • Use different accounts for money in and money out. This doesn’t cost more and makes it easier to see and track errors.
  • No petty cash – give the reception a debit or credit card. NO CASH.
  • Pay all accounts online – either direct or with credit cards. Apart from being easier it also leaves an easier to see audit trail.
  • Bank Feeds into MYOB or XERO are an absolute MUST. Saves time (and money) and is more accurate than you or your book-keeper. XERO feeds from Credit Cards may be incorrect.

PATIENT SOFTWARE BANKING – TO THE BANK

  • Bank Summaries each day from your patient software should always line up with your bank deposits. If they regularly do not match then you need to change the way your staff close off your patient banking. Yes we now have ours so they match.
  • Never close off Medicare until it is in your bank!

BOOK-KEEPING – ACCOUNTING

  1. Excel Spreed sheets – you need one for each of the following
    Long service leave – As a minimum do it at the end of each year. MYOB will not give accurate figures. The premise of MYOB’s calculations is incorrect.
    Depreciation schedule/Assets: this can be a third party addition to XERO but not really worth the expense? You need to do this yourself. Your accountant may lump equipment together and this makes it really hard to write off single items. e.g if you buy a chair and an xray unit and etc together.
    Partners distribution: We do this monthly on excel just because it is easier but it is then entered into MYOB so we can see it at any stage; auditing is better via MYOB.
    Other excel sheets: If your book-keeper or accountant uses excel for BAS or wages then they probably don’t know how to use the software you are paying for.
  2. Profit/Loss; Balance Sheet; Depreciation; BAS and GST
    You are an intelligent dentist. You need to get your head around these terms. I bought the “Dummies guide to Accounting”. It helped with some of the basics. I also bought the “Dummies guide to MYOB” and found that I then knew lots more than my accountant and their book-keeper (very annoying!). People don’t necessarily keep up with the software changes so they do things the old long way.
    Profit and Loss – Money in and Money out. This is the most basic concept. Your expenses are listed without GST (the system takes it out for you!).
    Use Subtotals in MYOB and XERO for a better picture.
    You need to add in depreciation to this concept as not everything you buy can be claimed as an expense in the year it was bought. ! IMPORTANT – this means that your “profit” and the money you have in the bank will not necessarily match.
    Balance Sheet – Go to the Balance Sheet to make sure your bank totals match your MYOB or XERO bank totals. The Balance sheet is also where you will find how much GST you OWE at any time. If your accountant has to give you an end of year adjustment to get this correct then you are not using MYOB or XERO correctly.
    Depreciation – Yes this is an odd thing to understand. Spend time on it. You will also then find you should be keeping an asset register etc. Depreciation is really important. It means that you are paying tax on money you have already spent on depreciating items.
    BAS and GST – all your payee accounts in MYOB/XERO should be set so it automatically gives the correct GST rating and correct expense category. If not then you need to spend 1 hour setting this up. It will save many hours later.
    XERO and MYOB give you the BAS information very easily. Do an online lodgement and it will take you 10 minutes to do a BAS statement.
  3. Register for and AusKey and do your BAS online -very easy to do both of these. If you are a MAC user – use Firefox as your browser.
  4. Expense accounts
    The expense accounts are YOUR expense accounts. If the accountant is moving things around  – they are just stuffing you around to justify their fees. Your system should be set up so it is automatically correct.
  5. Income accounts
    Our income accounts match our bank entry categories – so you can chase problems (which we of course never have 🙂 ).
    Our partner totals are also entered, in addition, so you can match the patient software totals with the bank totals.
  6. Journal entries
    This is fun. Learn how to do them.
  7. MYOB vs XERO
    XERO is better for bank feeds, much much better. MYOB has better reports and easier to find information. MYOB has better year to year comparison (especially if you leave the previous year open)
  8. DO NOT use Spend Money or Receive Money in MYOB or XERO unless absolutely necessary. These are not helpful for reporting etc.
  9. Difference between an Accountant and a Book-keeper
    An accountant is what you need for “higher” level information. e.g. setting up trusts; tax fraud etc. A book-keeper is the one who needs to know how to set your systems in place for easy entry and monitoring. They wont necessarily think about easier ways of doing things, and why should they if they are being paid by the hour.
  10. Borrowing your watch to tell you the time
    Consultants are defined as people who “borrow your watch to tell you the time”. We have MYOB set to show accurately our OASIS totals, monthly and yearly. If you need an accountant to audit the obvious then your systems might be better set up.

Glenda Farmer is not an accountant and hasn’t even done a book-keeping course but is happy to come out to your practice and help you understand and set up good systems that work for you. (Melb Metro area – unless you want to fly me somewhere!)