Anyone who has spoken to me about Dental Practice Accreditation will know what I think. Accreditation is a great idea in theory but in practice it loses out.
Unfortunately it is easy to pass accreditation without actually committing to the systematic focus (or any change whatsoever). How easy is it for “accreditation” to just becomes a lovely poster on the wall and a stress in 2-4 years about “having to start all over again”.
Latest news about Changing Accreditation
The latest news in the accreditation world is that the ACSQHC (the organisation which sets all the rules for accreditation) has totally re-written the healthcare accreditation standards. All healthcare organisations* who were using the present standards will switch to the newer, clearer standards from Jan 2019. * Except for dental practices who are advised not to consider the new standards because the ACSQHC is developing a new set of standards for primary care. Reading the discussion paper October 2017 Patient safety and quality improvement in primary care Consultation paper.
The consultation paper from ACSQHC includes a number of interesting propositions:
- Just because we don’t have quantitative records documenting lack of safety or quality, does not mean that there are not issues. e.g ACSQHC thinks there are problems but they just not sure what they are!
- “A systems focus, which involves making changes at an organisational level within services and reorganising care delivery systems, will help support improvements in the quality of primary care and ensure it is sustainable, efficient and effective.” According to the ACSQHC.
- “Private Health Insurance funds are one of the drivers for improved safety and quality and are driven by the need to ensure care provided represents value for money, and that care is clinically appropriate and in line with best practice.” – or so reports the ACSQHC!
The ADA has made a submission toward this Primary Health Care paper. The ADA will be a party to the development of Primary Health Care standards. As the PHI is now recognised in this paper as a primary stakeholder towards safety and quality by the ACSQHC it will be interesting to see how involved they become in dictating the new standards.
The Best of Accreditation ideals
Following are my recommendations for practices wishing to explore the ideals of accreditation.(With or without paying QIP for the accreditation certificate):
- Start using an incident reporting system so you can actually track incidents or near misses. Yes that would include stuff ups at the front desk; appointment mix ups; broken files; fillings failing too early; staff running over their feet with their chairs etc and it would also include compliments from patients – use them in marketing yourself.
- When you have any incident, then objectively review it from a systematic perspective. Can we devised a system, at work, that would make this incident less likely or impossible. Don’t expect staff to be hero’s in the smooth running of the practice. Risk Management is the name of this analysis. If you decide to do nothing – document it.
- Have policies (yes generic feel good policies) but also look at practical procedures. Video what happens with your iphone if quicker (put it on a private youtube acount – no cost). This is an excellent training resource or new staff induction resource.
SmartDentist supports an easy way to support practices with these processes.
Easy systems = Good systems = Practical systems.
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:
- as required by law
- written down (computer is ok)
- 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:
- Do they also service and repair sterilisers?
- Do they provide a validation certificate and records?
- Will they remind you when validation is due again?
- Do they require staff to supply a range of “usual packs” of instruments?
- 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:
- Add your Steriliser to Equipment Register
- Set up a Service timetable
- When the service is due and completed upload the validation certificate and the service timetable will re-date to the next service time.
I am probably one of the most experiences people at uploading documents, for Dental Practice Accreditation, into QIP AccreditationPro. ( A service offered by SmartDentist as it is a really time consuming task)
Yet, I have only just realised that I can make the upload system better for both QIP and myself.
In the past I have named the upload documents according to their content. This results in a messy document list on QIP because QIP sorts the uploaded documents alphabetical.
(see below – very messy)
To create a useful document list
Try naming the document by the action number e.g. the Governance policy becomes ‘1.1.1 Governance Policy’. Then you have a document list in QIP that can be checked against the ADA document evidence list (available as a handy cheat sheet on the ADA website).
This also will help QIP as they do a check to see all your documents are present. Remember that 1.7.1 needs to be listed as 1.07.1 or the sequence wont be correct when you come to 1.15.1 !!
“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.
More efficiency in pre-Christmas madness
The pre-Christmas time of the year prompts us to think about the many things that we would like to do and achieve; which complicates this time-poor season of the year.
Mindfulness principles* show that efficiency is enhanced when we have some way to remove, from our immediate attention, those forward planning, distracting thoughts and ideas.
Just as smartphones, diaries and calendars help un-weight our brains, SmartDentist has the idea place to ‘store’ these great ideas for later use or consideration. (Out-of-Brain Storage!)
Go to RESOURCES > CONTINUOUS QUALITY IMPROVEMENT
We have 2 forms you can use to store ideas. Try quickly jotting your ideas into SmartDentist during the work day so you can return more focused to your immediate tasks.
After Christmas look at your SmartDentist plans. They will become your practice’s Continuous Quality Improvement Plan, or you can simply delete them.
Practices who are accredited need to have a Continuous Quality Improvement Plan and this SmartDentist area prints off into the QIP format as a Quality Improvement Plan.
May you have a relaxing time with family and friends this Christmas.
*Mindfulness is about managing pressures and enhancing performance.
Mindfulness is now taught to university-wide at Monash University. The next free on-line course starts Feb 8 2016 (Enrol now)
#Christmas reading suggestion: The Organized Mind by Daniel Levitin (Thinking Straight in the Age of Information Overload)
Even if you are not doing Dental Practice Accreditation you may like to hear about what is happening.
- I haven’t heard that Dental Practice Accreditation is about to become compulsory for private practitioners. This is despite some CPD courses advertising using fear and innuendo about “impeding compulsory accreditation” as a marketing suggestion. (Which is great for SmartDentist!)
- New fees have been released for dentists undertaking the next round of dental re-accreditation. Yes it is higher. Also on offer is a 3 hour practice inspections for an extra $1500. Technically the accreditation surveys can look and question you on any of the 108 required actions.
If you are looking at the most cost-effective you would take the 4 year option with a 30 minute phone interview. (That makes it $379.50 per year for the accreditation logo!)
- Slight variations in accreditation requirements with changes from the governing body, ACSQHC. e.g. traceability and the need to monitor staff use of clinical guidelines.
With respect to the specifics of QIP acceditation you need to supply your steriliser validation certificates which all practices should get each year. Also staff (Dental Assistants) Education and Training Register. Yes, SmartDentist has had staff training and a register for years! With SmartDentist you can even add in your own competency training for staff and set up a whole staff training calendar.
- For those using the ADA Policy templates the policies have been slightly modified. Instead of 10 policies they have changed the number to 6 but the missing policies are just included under the Governance policy heading. I think it will be more sensible at present to leave the policies separate. Especially in light of No.6 below but you can do either in SmartDentist.
You might notice that the ADA/QIP has taken on-board the SmartDentist idea of a compliments and complaints register. You will also find that the Hand Hygiene Audit has been modified so it is similar the SmartDentist original hand hygiene audit (more sensible).
Be conscious of the wording in the ADA templated policies. Instead of using the ADA wording “ensuring our staff do …” I think that dentists might decide more sensible and safer wording would be “take steps to ensure our staff do …”.
- Only one ADA member needs to work at a practice for it to use the ADA templates and accreditation model. e.g. the owner doesn’t need to be an ADA member.
- In 2017 the Standards against which dentists will be accredited will change. If practices are using Smartdentist the change should be as seemless as possible because we will “map” the old accreditation actions to the new Standards for you!
The new standards will lead to changes in accreditation requirements. Stay tuned.
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!
Quality and safety improvements are a continuous aspect of the life of a dental practice. For practices who have completed the ADA Inc. and QIP “Introduction to dental practice accreditation”, time may be near to submit a quality improvement plan.
QIP will supply you with a template for the plan but it can have many different forms.
ACSQHS requires all healthcare organisations to have an organisational quality improvement plan.
How to make a suitable plan
When putting together your quality improvement plan, the ideal is to align your dental practice improvements with one of the actions/criteria set out in the National Health Service Standards (NSQHS). There are 104 core actions/criteria for dental practices and 48 future actions for dental practices to be working towards.
The process of aligning or mapping your practice evidence or documentation to the National Standards criteria was done for you by QIP and the ADA Inc when the practice used the QIP pro accreditation login. Because they made it so easy for practices to progress through and pass accreditation many practices are not very familiar with how the ‘mapping’ worked or what the criteria are that practices need to ‘map’ their quality improvement activities against.
By mapping your quality improvement plan outcome documentation (what you do and how you show you do it) the dental practice will be well on the way to future accreditation and moving to a process that aligns better with the context of your own individual practice.
Check out the SmartDentist youtube on the innovations we have made to help practices both form their own quality improvement plan and work towards their next accreditation.