Getting back on track: Signoff dental policies and procedures

Getting back on track with policy management

“Sorry officer, I didn’t know!” Our short NSW holiday over the Christmas break was soured by a U turn at a set of traffic lights (fine $263). Yes, it is legal in Victoria but we now know it is not legal in NSW! We should have read the rules BEFORE we drove into NSW.
We don’t want to employ staff who say the same thing about our policies and procedures. While “I forgot” is annoying, having a staff member say “I didn’t know” is becoming a greater risk to business. Because our policies and procedures are increasing in number and importance we need a simple way to make sure our staff have access to and know about our policies and procedures. The Dental Board of Australia (AHPRA), Fairwork Australia, and Work safe seem to have a similar outlook to that NSW traffic cop and there is little tolerance of ignorance.

Helping the small business comply with the ever-increasing demands is best done by SmartDentist!
Our clever content management system allows employees immediate access to every  new policy and Smartdentist has communication systems to allow you to easily communicate policies to employees.
“Smart” employers can keep track of staff signoff and be comforted knowing that staff have access to policies 24/7. What better way to have a feedback loop online so changes can be made ASAP.

Employer guide to:

Getting back on track with policy management

  1. Go to All Policies and select the Executive report on Polices and Procedures
  2. Check if policies need to be reviewed and update (use bulk update or update individual policies).
  3. Check any additional template policies available in our Policy library.  Have you considered the new policies for your Human Resources Manual? There are over 60 policies for you to consider from our template library.
    You don’t need to let future policy additions stop you from gaining employee signoff and acknowledgement right now.
    Be relaxed in knowing that at any time in the future you can email a new policy directly to every employee and then checkout signoff for that individual policy. You can also checkout when your staff have logged into SmartDentist.

Employee acknowledgement / staff signoff

The best time to get employee’s to signoff, that they have read and understood policies, is when they are first employed.

A. New staff members

Use the New Staff Induction Checklist (HR > New Staff Induction) and you will find a link to PRINT all policies. You could print to paper or print to pdf and email all policies or a selection of policies (e.g. infection control manual or human resources manual), to the new staff member.
We also recommend you print off the “Manage Policy Signoff Requests” page for an individual and use it as a hard copy to save in a staff member’s employment file.

B. Existing staff members

Start the new year with the following process.

  1. Send all staff members an email saying that you will be doing an update on all policies and procedures to make sure that:
    a. we are all working together the one way for efficiency and time-saving,
    b. standards of accreditation and compliance mean there is a greater need for staff to help make sure our policies and procedures are correct and correctly followed.

    Let staff members know that further details will follow and they will be asked to signoff to say they have read and understood each policy.
    Ask staff members to make sure they can login to SmartDentist.
    Suggest that they save their password in their mobile phone under NOTES in the practices Contact details. One of the biggest time waster and sources of frustration is a staff member who can not login. Make sure staff members know they are not to login under someone else’s login and that you can not log on if someone else is already logged on in the one browser on your computer.

  2. Get ready to help staff with your request for signoff.
    a. Print off the individual “Manage Policy Signoff” for each individual staff member (Policies > Signoff)
    b. Print off one copy of all your policies
    c. Place these in a folder somewhere that staff can access them.
  3. Send another email asking staff to signoff on every policy explaining the location of the printed signoff and policy and procedure manual at work (so they can read and signoff without a computer being free) and that they need to have both Smartdentist and their personal signoff sheet completed. e.g. they need to get familiar with login to Smartdentist to access policies and procedures.
  4. Monitoring signoff
    The “All Staff Signoff page” gives a quick overview so you can see how everyone is progressing.
    As the administrator of Smartdentist you can also see when a staff member logged into Smartdentist and how frequently (HR> Staff profile). If they logged in and logged out you can also see the time they spent.
    Make sure you follow-up each individual.

What if a staff member refuses to signoff on policies

If a staff member refuses to signoff on a policy then it is important to have a calm and rational discussion about why they wont signoff. It is best to ask for this in writing BEFORE you address their concerns as it will allow you time to consider their viewpoint.
Sometimes there is a mistaken belief by staff members that if they don’t signoff then they don’t need to do what the policy says. This is incorrect.
You can not force a staff member to signoff a policy. You can performance manage a staff member who refuses to do what your policy requires.

 

 

 

 

 

Dental Policies and Procedures: practical or dust collectors

Dental Policies and Procedures on SmartDentist are practical and not dust collectors. Smartdentist model for dental practice policies and procedures is seeing more and more subscription from a couple of different types of dental practice.

  1. Dental Practices who have rarely looked at their printed Dental Policies and Procedures.
    These dental practices are very aware of Dental Board legal requirements for an Infection Control Manual. Dentist like to see themselves running “best practice”. On a practical level these dental practices are time short; have long-term staff who are skilled in doing their job, not writing about it!
    These are Dental Practices aware that having current policies and procedures is GOOD RISK MANAGEMENT. SmartDentist Templated Policies and Procedures are in “bite sized” chunks and written with a normal dental practice in mind. Anyone can modify these ready-made policies to fit their own practice model (if necessary).
  2. Multi-site or bigger dental practices are becoming a big part of SmartDentist content management for policies and procedures. Often experienced Dental Practice Managers have become very aware that policies and procedures can be useful for:
    a) Efficiency: reducing variations in multi-staff environments
    b) New staff orientation: professional and quick orientation programs were written lists make for better training.
    c) Communication: using email to let staff know about changes.
    d) Convenience: One place; online for 24/7 access
    e) Cost saving and time-saving: Most office managers love to work with teams and not spend days on paperwork.
    Smartdentist content management has features not available anywhere else. Smartdentist is a solution rather than a system!

Why SmartDentist Content Management Solution for Policies and Procedure

SmartDentist constantly works towards making usefulness the focus of policies and procedures. Our innovations are things we want for our own practice, and we keep improving to make using policies and procedures practical and worthwhile for big or small organisations. Rarely do you get insights into other dental practices policies and procedures: In SmartDentist you will find an expanding range of policies and procedures which can be adapted to serve regulation compliance and practical solutions. User friendly!

For dental practices by dental practices.

How to make your own workable Infection Control Manual

I have heard dentist say they do have an infection control manual because they have the ADA  Infection Control Guidelines!
It’s a great start but it is not what the Dental Board or the ADA wants you to consider as your OWN Infection Control Manual.
However if you want to do your own manual you can’t start at a better place than the ADA guidelines. Try the following to make your own practical manual –

  1. Print off the whole of the ADA Infection Control Guidelines
  2. Cut the guidelines up into sections representing work zones in your own clinic.
    e.g. What part of the guidelines gives insights into the actions of what part of your clinic?
  3. Label pieces of paper according to work zones or work procedures.
    e.g. cleaning up after patients.
  4. Put the heading “Policy” onto those labelled pieces of paper and then stick the printed part of the ADA guideline onto that paper.
  5. Follow the policy with the word -“Procedures”.
  6. Get the staff to write down “point form” (e.g. as a list) what actions they take. You can also video with your iPhone instead of writing and have an online procedure.
  7. Do the same with the ADA practical guides and then the Standards Australia reprocessing standard.
  8. Congrats you have a practical procedure manual. (alternatively subscribe to SmartDentist)

What does the Dental Board of Australia and other regulators want?

The DBA wants you to DO what your policies and procedures say you do!
SmartDentist helps with small readable, discussion type training exercise’s in the areas of infection control where we get the most questions.
SmartDentist encourages the use of practical procedures which are linked to; but separated from lengthy formal policies.

Changes in Dental Practice

Dental practice moves forward with the times. Computers are common place. Each staff has a smart phone. Often it is an iPhone. Gone are the days when dental practices were advised that the best manual was a printed dust collector.
Dentists time is best spent in the clinic doing what they are trained for.
Consider SmartDentist…it’s just the smart way to go.

How staff learn or why policies and procedures don’t seem to work

Nothing has frustrates me more than introducing a new process at work, or streamlining an existing process. Why haven’t staff followed my very comprehensive, written procedures!

Since starting SmartDentist I have gained a greater understanding of what Policies and Procedures are good at; how to make them better; and what they wont do for the practice.
The following hints and learnings aim to help others who have suffered similar frustration. Consider:

  1. What Policies and Procedures are good for
  2. What Policies and Procedures wont do
  3. Better printing of Policies and Procedures (SmartDentist)
  4. Great understanding about our staff and how people learn

What Policies and Procedures are Good for!

1. Making sure AHPRA doesn’t ‘get’ you! Yes you need an Infection Control Manual (made of policies and procedures) because the Dental Board requires one. In Q’LD you also need policies and procedures so you have an Infection Control Management Plan. Dentists don’t really learn about this aspect of practice management in University yet we are legally responsible for what happens in our dental practice reprocessing. Practitioners benefit by considering creating a set of policies as worthwhile learning tool. The procedures used by your DA might not be correct or efficient. (The way we were shown in the past is the greatest predictor of what we do in the present. ) A good set of policies can help a practitioner understand and streamline or update procedures. They are a great insurance policy guarding against the stress of the loss of a knowledgeable staff member.

2. Having a procedure where everyone does the same thing the same way. Not only is this a safety precaution but it means life actually becomes easier for everyone (saving time and money). Established policies can sit on the SmartDentist website (untouched) until a new staff member needs them as a teaching aid. It is very handy to have good written procedures in case a significant staff member leaves. These need to be refreshed every so often. DON’T expect staff to look at these policies once everything is running well.

3. Performance management. When there is a communication breakdown or dispute about staff actions there needs to be formal written procedures in place in order to evaluate future staff actions or performance. Staff cannot refuse to do something that is reasonable, part of their normal work or customary. In regards to infection control practices, a staff member can not engage in conduct that causes serious and imminent risk to the health and safety or a person or the reputation, viability or profitability of a business. Of course staff would need adequate counselling, education and help to undertake their performance tasks. (see below – How staff learn)

What policies and procedures wont do

  1. Policies wont work without work.
    Policies and procedures should be living documents of excellence /efficiency. Often people are just too busy doing the job they have been given to actually question the processes of the job. Give some time to considering if processes are necessary and are efficient. Not every policy needs changing, not every task needs explaining but some processes will need more complex explainations or reviewing. Each policy review is the opportunity to get rid of old fashion inefficiencies or streamlined procesess.
  2. Written policies and procedures wont save a practice from workplace disputes. Just because you have a policy in place doesn’t mean you can discipline someone for not following it. You need to educate, tell, do and find out why they aren’t doing something. Workplaces are gigantic relationship centres and relationships require work and tolerance and give and take.

Better printing of policies and procedures (SmartDentist)

In developing better policies it can be helpful to consider what you find useful in instruction manuals. Many people only use instruction manuals when they can’t work out how to use the system or object. Instruction manuals that include relevant pictures are easier to follow and instruction manuals written in short point form are easier to read.
Hence it has been found that most used policies /procedures are:

  • short
  • easy to read
  • and help staff when faced with an uncommon process or problem

Consider developing two different types of policies. One could be for practical use and one for legal requirements or complex justification (e.g. infection control policies).
We only print policies if they have instruction for unusual or stressful processes, or if constant reminders of their content need to be seen by staff.
[For example I have the following policies located at our reception: Start of Day Reception; Middle of Day Reception; End of Day Reception; Payments and Hicaps.
These are separate laminated, two-sided documents printed out from SmartDentist. I have found longer policies are best divided into 2 separate policies (if they need printing and laminating). When a policy is updated it is easier to simply change a single sheet of paper.

How to print more useful polices from SmartDentist
Each SmartDentist policy has a small icon next to the name which reduced the “guff” off the policy. It also has the date on the top of the policy.
(Guff = resources; links; National standards etc. When submitting for accreditation please include the “guff.”)
Using the icon to gain a shorter version of the policy will also print better lists and save paper.

How our staff learn

Most of our staff are kinesthetic learners. They learn by doing. Learning should follow the following sequence – Tell; Show; Do; Review…and do this over and over again.
Do you know that changing a habit generally takes two months? That is two months of constant persistent reinforcement – do and review; do and review.
We communicated changes via:
1. Staff communication book
2. Verbal communication
3. Emails from SmartDentist – using basic communication form or the policy communication.

Consequences :- If there are no consequences for not changing, learning will take longer and reinforcement will need to be more persistent and regular. What consequence can staff introduce to remind them of the need to make procedural changes?
Self-care: – Find a mentor or supporter to encourage and reminding you about 1) your own inability to change 2) about the great things the staff do everyday without instructions!

 

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, specialized in cosmetic procedures such as whitening, we also recommend using Charcoal Teeth Whitening for a natural process and for before the procedure to maintain a perfect smile.

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

Sterilizer records for dental practice

[or how to put your old Mobile phone to good use]

Login to SmartDentist and check out the “Steriliser Documents and Monitoring Policy”, or if you aren’t part of SmartDentist look at the ADA guidelines for Infection Control P28 (and P20).

How do you improve the efficiency of your document storage and collection?

  1. Establish a routine. Doing the same thing for every instrument is most efficient although it isn’t required. If staff don’t need to work out separate processes for different instruments the time saving is immense.
  2. Use an old Mobile Phone. Are you collecting paper copies of sterilisation documents? If you are then use an old mobile phone to take photos of printout and your sterilisation log sheets and download these when the phone gets full. You can leave the phone with its charger in the steri room. The additional benefit is that the photo’s taken with the phone will be dated (make sure it is always charged so the date is correct)
  3. Sterilisation log book -(our practice has a sterilisation log page). All tests are recorded within the one sheet. Our packs are labeled with a date and cycle self-inking stamp; and so it out sterilisation log page. The sterilisation log page can be scanned onto the computer (make sure it is located somewhere so it is saved for 7 years e.g. into patient computer software is ideal) for storage or a photo can be taken and the image stored.

See SmartDentist’s Reference and document links page to download a sample Sterilisation log page as this might help you with your own system.
SmartDentist also has a “What tests do I need for my steriliser?” aid. See RESOURCES.

Infection control of hands [Week 3]

IMG_1757The ADA guidelines say you need in your infection control manual…

Information and specifications in the manual must include:
• methods of hand hygiene (both routine and surgical);

SmartDentist subscribers: Go now and delete you old hand hygiene policy and go to the Common Policy Library and select the latest Hand hygiene Policy. It will come with links to

  1. Hand Hygiene Australia ;
  2. My favourite youtube video on Hand Hygiene;
  3.  WHO: Hand wash and Hand rub poster;
  4. Donning surgical gloves (Ansell site)
  5. Latex allergy help site.

TASK for this week
Download the Hand hygiene poster; save it to a UBS; go to Office Works and get a copy printed for each wash sink (0.88 cents per copy) and laminate it (1.75 per copy).
Get some blue tack and put them up at work!
(See picture above: I really do do what I say. Here is a selfie of me with the 5 posters – one for each surgery and one for the steri-room)

 

 

Let’s follow the ADA [WEEK 2]

Let’s follow the ADA [WEEK 2*]Screen Shot 2016-02-05 at 4.16.03 pm

The Dental Board says you MUST have your own infection control manual.
So what does that look like? Guess what. There isn’t ‘one’ answer to that question.
But we are going to follow the ADA guidelines with our OWN manual.
To save you checking what the ADA guidelines says you need to include in an infection control manual I have copied the text from P31. (see below)

This week’s 5 minute infection control task* is to login to SmartDentist.com.au and go to POLICIES and find the link to the Common Policy Template Library. You will find a list with all our infection control policies. There are 16 in my list so make sure each one of these policies is ADDED to your policy list. This is very quick and I don’t expect you to read them at this time – just make sure you have added them in preparation for our future blog articles.
If you don’t subscribe to SmartDentist you could audit your policies against this list or alternatively start a Word Doc with the list so you can begin to create your own infection control manual.

(From P31 of ADA guidelines for infection Control 2015-
Information and specifications in the manual must include:
• methods of hand hygiene (both routine and surgical);
• personal protective equipment requirements;
• setting up the treatment area between patients;
• environmental cleaning protocol;
• defined zones that require barrier protection and cleaning between patients;
• protocol following an exposure incident, e.g. a sharps injury;
• handling and disposal of sharps;
• waste disposal;
• processing of reusable items (cleaning, packaging, sterilisation, disinfection, storage);
• processing of radiographs in a manner to avoid cross-contamination;
• quality control mechanisms including documentation for the maintenance and monitoring of equipment;
• immunisation requirements;
• single-use items;
• recording of information during patient treatment in a manner to avoid cross-contamination;
• use of computers and computer-run equipment during patient treatment in a manner to avoid cross-contamination;
• management of waterlines used in direct patient contact; and
• handling latex allergy in dental patients and dental staff.
Practice infection control manuals must be regularly updated if and when new guidelines are produced by the Dental Board, the ADA or the NHMRC.)

[* Each week we will be looking at infection control compliance – just for 5 minute.]

Who sets the rules for dental infection control? [WEEK 1]

Who sets the rules for dental infection control? [Week 1]football-referee-with-hand-gestures_318-42804.png

Many dentists and staff get quite confused about the rules for infection control.
The Dental Board is the government regulator of dentistry and they say that dental practices should use 3 documents to guide their infection control procedures.

The documents are:

  1. The Australian Standard for reprocessing instruments (e.g how you clean and sterilize instruments) . Unless you are a hospital you will use AS 4815. An alternative standarad is a new version of AS 4187. This is a very very hard standard to meet so just ignore it for now. SmartDentist subscribers have access to AS 4185  via their login. It is 97 pages long and was finished in 2006.
  2. Australian Guidelines for the Prevention and Control of Infection in Healthcare published by the National Health and Medical Research Council (NHMRC). This document is available online and was finished in 2010 and is 262 pages long.
  3. ADA guidelines for infection control. This has just been revised and is about 50 pages long.

So why have 3 documents, and why don’t they just tell us what to do?

  • Each document is different. Yes, sometimes they can be interpreted to be in conflict or at least not clear about requirements.
  • The easiest document to read and understand is the ADA guidelines.
    ABOUT THE ADA GUIDELINES: Because the ADA is an organisation of dentists it is easy to understand that a government regulator would not be happy in just letting dentists decide on their own standards. Similarly the ADA looked at the other 2 documents which have wide ranging membership and tried to be practical and sensible in what it says dentists should do and use out of those other documents.
  • These documents are the source to go to if you are in dispute about what should be done in your practice.
  • You DON’T really want people to tell you exactly what to do because they don’t work in your building, with your equipment, with your staff or know exactly how your workplace functions. For example; in a big hospital do you need a first-aid kit when staff have access to emergency hospital care; do you need a designated spill kit for large spills of blood in a suburban dental clinic.
  • *When a sales person say…the ADA now requires you to ‘x’ then ask them to show you in the ADA guidelines before you buy their sales item. The ADA is not the government or controling body of dentists. They are a voluntary organisation.

Order of priority (by me)

  1. ADA guidelines: if that still does not solve your dilemma then –
  2. NHMRC guidelines for an overview of concepts and information apon which to base a decision.
  3. AS 4815 on technical requirements for sterilising and record keeping – just remember that it is nearly 20 years old and some things weren’t even invented e.g. USB sticks instead of printers.

NOTE: For those that play tennis, have a hit of golf or drive –

  1. Rules of Tennis – 30 pages
  2. Rules of Golf – 208 pages
  3. Road Rules NSW – 188 pages

 

Closer scrutiny -infection control in dental practices

“But no-one  else I know is…”

The most common complaint I have heard from dental practitioners, who have been “required” to make changes to their infection control practices, is that no-one else is actually doing what they are now required to do.
Of course this isn’t true but we do all have a universal wish to be treated fairly and to conform to the ‘norms’ of our peers.

The Dental Board of Australia (the Dental Board) should be commended for holding a forum of infection control stakeholders in late 2015.

The DBA got together with the ADA, consumer reps, the State regulators of dentists and representatives of the Australian Commission on Safetyand Quality in Health Care.
With the numerous cases of infection control breaches in NSW that have resulted in massive patient notifications about the risk of acquired infections, it isn’t a surprise that government bodies and regulators are really keen to have conformity and a universal standard of excellence for dental practices in infection control.

It will be interesting to see if the DBA chooses to include accreditation as a formal requirement for Dental Practices in the future.

Dental Council of NSW – making dentist uncomfortable

NSW Dentists are feeling uncomfortable

“The Dental Council of NSW is conducting an audit of infection control measures in dental practices.”
So stated an offical letter to all NSW Dentists. 

Not withstanding the proviso that it only applied to NSW Dentists who have an open complaint, it is a good idea to work through the directives from Dental Council of NSW and see that you have everything in order.

One of the requirements is a completed DBA Infection Control Guideline Self-Audit. Check out how SmartDentist answers the audit. 
Some practical practice resources:

  1. DBA Infection Control Guideline Self-Audit by SmartDentist.
  2. Sterilizer (autoclave) log sheet to use for your logbook.
  3. What tests do I need for my steriliser? by SmartDentist

Disaster recovery worst practice: Don’t test your backups.
Tomorrow I go into the clinic just to meet our IT specialist and we are going to do a backup recovery of our patient management software.
Similarly the DBA self-audit does take a bit of thinking and time – but helps get rid of that uncomfortable feeling we would all have, if we were queered by the Board.

Whether you are in NSW or another state…do the self-audit and smile.
🙂
Warm wishes for Christmas
Holiday well.