On 1st Oct 2015 the new ADA Guidelines for Infection Control were released and include the statement that “the ADA does not support traceability”.
However the ADA supported dental practice accreditation program was changed on the 8th Sept 2015 so that a ‘traceability’ system is now a compulsory requirement of dental practice accreditation.
Wow, are you a bit confused? And if you are a dentist or dental practice manager you are not the only one confused.
Has the ADA decided to drop dental practice accreditation?
I don’t believe so.
The confusion has occured because the ADA ICC has decided to define traceability as a protocol whereas other organisations such as Standards Australia AS 4815 (Office -based reprocessing…) or Standards Australia 4187 define it less prescriptively. The ACSQHC which governs dental practice accreditation requires traceability but they also say that this is a term that will vary depending on your healthcare context.
The ADA Guidelines for Infection Control 2015 state “BCI (Batch Control Identification) is clearly designated as a mandatory requirement in AS/NZS 4815 and AS/NZS 4187.” However AS/NZS 4187 doesn’t appear to mention BCI or Batch Control Identification. AS/NZS 4187 appears to call these same actions as ‘traceability’.
The definition of traceability shows how strongly ADA ICC feel for their current definition of traceablity as a protocol. In the 19 years I served as a member of this Committee they were consistent with their current definition.
However as no-one else uses the term the same way perhaps the ADA could have made things less confusing for dentists if they had explained the differences (e.g. Standards Australia and the ACSQHC) and used the same terms the same way!
SmartDentist has a new CPD exercise for staff and dental practitioners on Traceability and the Dental Practice requirements. In this CPD exercise I tell you what we do in our own general dental practices so it may give you ideas for stream-lining a simple manageable system. I would like others to let me know clever ways they manage this requirement.
SmartDentist now also has a new templated Traceability Policy for practices that want to set out all the connecting parts of their traceability system clearly.
PS. I think the new ADA Guidelines for Infection Control are a great improvement in clarity and readability in most aspects.
Feb 2015 – Coroner reports a dentist to the Dental Board of Australia following an inquest into the death of a female patient.
The death of anyone is the worst nightmare for any health care practitioner. And to be implicated in the cause of death is quite tragic.
This case was one where the female patient was on warfarin and died of blood loss two days after teeth had been extracted.
The dentist was criticised by the coroner for a number of things:
No written note of the INR
Not following the therapeutic guidelines on managing a patient who is on warfarin with minor oral surgery.
One of the thought provoking inferences was that the dentist should have been using tranexamic acid mouthwashes with this patient.
Tranexamic acid mouthwashes – these are not available but you can mix an equivalent with dissolvable tablets. The patient will need to buy 100 tablets and use 9 of these over the course of 2 days. If the dentist purchases and sensibly redistributes these the labeling and control of these tablets could turn out to be a nightmare. Also just writting the original script needs lots of consideration as these tablets are NOT to be taken orally for people who have had blood clots in many parts of their body.(Many patients on warfarin fit into this category)
I can’t imagine the families distress at losing their mother with a preventable incident.
I would like to fully incorporate all the learning from this tragedy into improving safety and quality in my practice. The big question is how to best manage the use of tranexamic acid, without causing another problem to someone else!
Recently there has been a call from the Dental Hygienists’ Association of Australia (DHAA) to make sure current evidence based research finds its way into current practice. From my own experience with ADA advisory committees such as the Infection Control Committee I know the committee members focus on evidence based research. They also look at context; the experience of a widely divergent group of practitioners; underlying science in decision making and practical needs.
In addition the NHMRC infection control and prevention guidelines focus on risk assessment and risk management so context again has become the ‘buzz’ word like patient-centred care.
It would be a great idea to merge all the resources of training bodies, the ADA and Universities so dental assistant training transitioned into a context based learning. Context needs to be an important part of flexible dental assistant training.
This is the most common question I get from Dental Assistants. It is also one of the most controversial aspects of practice protocols, especially when a new staff member comes into a practice.
At our practice we use barriers extensively. Why? Well we philosophically believe that this is must be the superior system because we do it(:))… but basically we do it because that’s what we were taught…it’s what we have become familiar with…and it’s what we therefore are setup to do and we find it quickest. But it is not necessarily necessary.
What does the ADA Inc guidelines say…What is the DBA ruling?…If you don’t know then perhaps it is time to do SmartDentist’s latest CPD /training exercise for dental practitioners and dental assistants on Barriers and infection control.
From Craig Lyon
Craig Lyon & Associates Pty Ltd
Suite 3, 1st Floor, 136 Canterbury Road (PO Box 805)
HEATHMONT VIC 3135
Ph: (03) 9729 7592
Contained in last week’s budget papers was confirmation that the government intends to introduce a $2000 cap on tax deduction claims for work-related self education expenses. The proposed commencement date for this measure is 1 July 2014.
In the Treasurer’s 13 April 2013 announcement of this measure, Mr Swan defended the move on the basis that without a cap, “it is possible to make large claims for expenses such as first-class airfares, five-star accommodation and expensive courses”. Continue reading →