The Compliance Divas Podcast
Our podcast covers current topics such as infection prevention and control, OSHA and HIPAA compliance for dentistry. We discuss the latest regulatory information, answer frequently asked questions and give suggestions for dental practices to make compliance easy and sustainable. The Compliance Divas are a trusted source for consistent, accurate information based upon current guidelines, standards, science, and recommendations.
The Compliance Divas Podcast
#201 Patient Safety Awareness Week - The 3 A's That Matter
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Since 2002, Patient Safety Awareness Week (PSAW) aims to promote patient safety throughout healthcare. This week the Divas share four key patient safety strategies for every practice and the three "A's" of patient safety and more.
Resources:
- Institute for Healthcare Improvement (IHI) - https://bit.ly/4icWtdL
- IHI - Patient Safety Essential Tool Kit - https://bit.ly/429jmZP
- University of the Pacific Dugoni School of Dentistry - health history forms in multiple languages - https://bit.ly/45Yd0g5
Welcome. I'm Leslie Cannon. I'm Mary Gavoni.
SPEAKER_02I'm Linda Harvey. I'm Olivia Juan. And together we are the Compliance Divas.
SPEAKER_00Welcome to the Compliance Divas Podcast. This is Linda Harvey, and I will be your moderator for this episode. As the Compliance Divas, we bring clarity and simplicity to compliance by navigating the regulatory world to keep you on track. We invite you to subscribe to our podcast on your favorite podcast channel or on our website, thecompliancedevas.com. Any questions that you have may be submitted to support at thecompliancedivas.com. And at the end of the podcast, we welcome you to scroll down and leave us a comment, a like, or any information that you'd like to know. This week marks the 23rd celebration of the Patient Safety Awareness Week. Back in 2002, a small group of people came together to establish this organization, including a family advocate for a child who died from a medical error. So we have to think about patient safety as being year-round, even though we celebrate Patient Safety Awareness Week this week, but it's always a year-round process. So today the divas have four tips in key areas, as well as the power of A to share with you. So let's jump into our conversation. I'd like to ask Mary to jump us off with your first tip, Mary. Thanks, Linda.
SPEAKER_03My tip is about eye protection for patients. I get questions, and I'm sure the rest of the divas do as well from practices all the time. What does OSHA say about eye protection for patients? Well, they don't say anything because that is not OSHA's jurisdiction. But the CDC guidelines for dentistry and for healthcare do encourage the use of protective eyewear for patients. And we all know that there's, of course, spatter and splatter, but we also have the potential for projectiles coming out of the mouth. We we know they hit our own safety glasses when we're working, and they're coming out of the mouth at roughly the speed of the RPIs of the handpiece. And we're rinsing teeth with acid etch gel that can be very irritating to the eyes. So eyewear for patients is a really great idea. It is part, again, of the CDC recommendations. And it's also a risk management issue because you don't want a patient to suffer an eye injury and you have the liability for treating that eye injury. So you have two choices. You can have reusable safety glasses, perhaps something similar to what the team wears, making sure that they get cleaned and disinfected in between patients. I always recommend that you wash them with soap and water first and then take an alcohol wipe for some disinfecting properties, because if you use your surface disinfectant that you're using on equipment, you will ruin the plastic on those safety glasses, including your own, very quickly. But there also are lots of disposable ones. You can get clear disposable shields that the patient wears once and you throw them away. You can get them that are tinted. So if the patient has a little light sensitivity, it's almost like wearing dark glasses that can help them. So either way, reusable or disposable. I know some pediatric practices like to get fun little sunglasses or cute little glasses that the patients can take home with them after they're done with their treatment. Lots of choices, but the point is protect your patients' eyes.
SPEAKER_00Great points, Mary, because we only have one pair of eyes. So we need to protect our patients' eyes. And in the world of risk management and patient safety, what you described, Mary, is known as a preventable medical error. So it is 100% preventable for any eye injury to patients by having them wear proper eyewear, not just their own prescription glasses, for example, when they're in the chair having treatment performed. Now I'd like to call in our Diva Leslie, who's got a tip that's a little bit different than what we would think about most of the time when it comes to patient safety. Leslie, what's your tip?
SPEAKER_01Well, Linda, I like to look at patient safety for the first time a patient sees a dental practice. You know, first impressions are important for our new patients, but our continuing care patients also expect that our practices are going to be safe places for them to be. And the first place that they enter our practice is the reception room. So I like to remind everyone that while we have the COVID pandemic in our rear view mirror, and we may have brought back the magazines and maybe the games or toys that the kids would play with at a little gaming table. We still need to be mindful about infection control measures because sometimes we may have, let's say, people coughing and sneezing in our reception, and they may not be the patient. We're usually lucky that patients will cancel their appointments when they don't feel well, but that doesn't mean that mom, who's harboring a cold or one of the siblings, doesn't have something. And while they're in the reception room, they may be spreading their infectious germs. And it could be that they're playing with the toys or even just coughing, singing, any kind of respiratory type of excretions that come out when a patient's in a reception room can affect others. So we should be mindful and still continue disinfecting the reception area. We should have creature comforts there. We should have a box of tissue, a wastebasket near the box of tissue for people to throw their used tissue in. We should have alcohol hand sanitizer that's readily available for patients and visitors to the reception room to use, and even that box of masks. Because I can tell you from my days of working in a dental office, when I sat at the front desk, if there was someone that was coughing and sneezing in the reception room, the other patients looked to me to do something about it. And they expected that I wouldn't just ignore it. So oftentimes, a nice way to approach a patient would be to ask that coughing and sneezing person, Are you feeling okay? Are you well? Can I get you a cup of water? And then maybe even escorting that person out of the reception. Perhaps you have a consultation room where they can sit, let me make you more comfortable here. We away from others in the reception. And I'm gonna maybe would you like a cup of coffee or some hot tea? And then sometimes patients that will get the hint that if they're not well, they'll go out to their car and wait for the other person to come in for their uh come for their appointment. The other thing that we can do is there are some signs that we can post in our reception room. And screening is still important. In California, it's a requirement because of the aerosol transmissible disease standard. But some of these signs that we posted during COVID are white noise now. And we look at them and we see right through them. They don't even target us. But recently, CDC did update their posters. They call it printable health and hygiene workplace posters for 2025. And in our show notes, we'll have the link for that. And these printable posters that you can have, they're for like restaurants and offices and workplaces, can remind people that if they are experiencing symptoms, to let us know. You know, we don't really want them to be in the practice and perhaps spreading germs to other people. Another area that I think we forget about is before we enter the reception room, there's always our parking lot or the walkway or the entryway to our offices. And I want to remind our listeners that for those of you that live in cold weather where the ground gets icy, that icy is very slippery and very dangerous and broken bones and people fall hard and you know could be hospitalized as a result of a slip and fall. And so please be mindful to check and make sure your premises are safe. If there's ice, put some kind of an ice melter down. If you have rainy weather, even rain water on the bottom of shoes hitting a flooring, a hard surface flooring can cause a slip and fall. So a mat, a rain mat would be something that would be like a welcome mat type of thing, or the type that goes into practice. And please don't forget to check the mat to make sure it's not wrinkled or flipped over because they can be a trip and fall hazard in and of themselves. If you have landscape and bushes or things like that, be sure and keep them trimmed and away from where people would open their cars and perhaps get hung up there, or if you have some landscaping where there might be some muddy areas, muddy can be very slippery as well. So think of the areas that are outside your practice. And one area in particular, I've experienced this myself. There was uneven pavement at a sidewalk during a at a medical practice where I was going as a patient. I didn't see the little teeny tiny, it was about an inch difference where the cement had settled between one part of the cement and the other. And I tripped and went right down hard on that particular little bit of a ledge. So take a look at your parking lot and see if there's any areas that might need to be ground down. It's not something that we can do. We have to hire somebody to do that. But do be aware that those are areas that are unseen and are very easy to trip and follow. And that could be not only disastrous for patients and their safety, but it could be a huge liability for the dental practice. Linda.
SPEAKER_00Leslie, I love your approach about patient safety, starting before the patient actually puts their foot in the office, much less into the operatory. That's beautiful. So you're we're describing what's called in the world of risk management an environmental assessment. You're checking, as you said, Leslie, the sidewalks don't have any uneven areas. There's no trip hazards out and around the parking lot. And if a practice has, say, early morning hours, because I know some offices that start at 7 a.m. And depending on what part of the country you're in and the time zone you're in, it could be dark. And some offices have evening hours, and it can be dark when the patients leave then. So making sure that your environment surrounding the practice is safe for patients as well as the team members. And then I love how you tied it into respiratory protection and respiratory hygiene in the reception area as well. Perfect examples of patient safety. Let's move into our next point with Diva Olivia, who's going to talk to us about something else that's very important with patient safety. Olivia?
SPEAKER_02Thanks, Linda. When we were talking about this topic about patient safety, I was thinking about the area of obtaining medical health history. And the health history form is actually the starting point for the practice's relationship with the patient, according to the American Dental Association. And I just want to stress how important it is to make sure the patient has fully completed a medical health history at that initial appointment. Not skipping over any boxes, making sure that it's signed, and making sure that the patient understands the questions and even inviting the patient to ask you questions. And also, I wanted to mention that sometimes patients, and this is the odd thing about it, they will access care at a dental office because they want to get their teeth cleaned, but you ask them, when's the last time you saw your medical provider? It may have been 10 years. So have their medical issues even been identified. So for example, I had an incident with one of my specialty clients where the patient had seen the general dentist, was referred to the specialty dentist. The specialty dentist, as a rule, checks the blood pressure of the patient. The blood pressure is too high. The specialty doc declines to provide treatment, sends him to the emergency room. The patient's blood pressure was that high that he was hospitalized. And the patient's question was, well, why didn't the general dentist check my blood pressure? So, you know, and you may be the only medical provider, so to speak, that's involved with the patient's care. So not only would we be obtaining that medical health history from the initial encounter, then we have to update it. And if you don't have a good version of a health history form, the American Dental Association does provide a sample health history form that may be beneficial to load into your electronic documents. And then thereafter, you want to update the medical history, which is typically done at the recare appointment, where you would inquire whether there's been any changes in the medical history and making notation. Now there's no legal requirement as far as how often to update the medical history, but it's so advantageous for the practice to establish some kind of protocol, at least doing a comprehensive medical history at least once a year. And then every single time that they come in, it doesn't matter if they come into your office 20 times a year. Or just asking those questions and making a notation of it in the clinical notes with your initials because medications can change. There could be interactions with the medications that are being prescribed by the dentist versus what's being prescribed by their medical provider. Also, when I was at the ADS meeting, I was speaking on the antibiotic stewardship. I just had a small part in one of the meetings, and how important it is to take the time to reach out to the patient's medical provider, whoever their primary care physician or nurse practitioner, to ask questions if there's any concern that the medications may have a contraindication with something that's already being prescribed. So we want to take the time to do that. And then the situation may come up where a patient refuses to provide a medical history. And I would say, hands down, that that is such a dangerous patient to accept into your family of dental patients that you treat, because without an accurate medical history, you are blindly treating the patient, which could result in an adverse occurrence. And in speaking with our divas earlier, one of the things that we pointed out is, you know, not only is it important to update these medical histories, but what about your emergency kits and the drugs that you maintain in your office for emergency situations? Are we ensuring that they are not expired? Because what if there is a medical emergency and you reach for your emergency kit and either one of the medications is missing or it's expired, what would we do then? So I think those are a couple of tips that we can share, Linda, on update or gathering, obtaining the medical history, and then updating the medical history regularly throughout the patient's treatment and it being part of the practice.
SPEAKER_00Wow, those are some fantastic points, Olivia. And before I provide some follow-up thoughts on that, I think Mary has an additional comment that she'd like to offer.
SPEAKER_03I did. And I'm so glad, Olivia, that you mentioned about making sure that the medical emergency kits are up to date. And so whoever your provider is that you work with for those updates, make sure that you check with them to see if your state requires you to also add NARCAN to that cadre of drugs that you have available. Many states have passed laws that have said that these medical and dental practices need to have these on hand so that you can hopefully treat someone, save someone's life if they did have an opioid overdose. Hopefully that won't happen in the practice, but you just don't know. So good idea, contact the company that you do your update through, or contact your state dental board because they would have information as well.
SPEAKER_00Prevention, prevention, prevention. So knowing what you need is as Mary and Olivia both suggested. And and also, Olivia, I just want to circle back to your comment about the medical history and this being the start of the patient relationship. That is so true. And it almost seems like an obvious point, but I bet many providers and team members don't think of it that way. Because just one more thing we check on the box, like, okay, the patient made the appointment. Have they been confirmed? Did they complete their forms? Either they're doing it online before they come or they're doing it in person when they come. And then you're moving on to the next step. Oh, I've got to get some x-rays for the doctor. So it goes on and on and on. We're not stopping to focus on these important aspects. When we don't stop to take a little bit of time for focus, and it just doesn't take very long, then that's when we're apt to make a mistake. So this is an important piece of that patient care process. So medical history is not just once and done. And Olivia, this ties into something that I wanted to talk about, and that's just risk communication with the patient, communicating effectively with patients and particularly related to the informed consent, but also relates well to the medical history and even asking questions in a good fashion so we can elicit more than just yes or no from our patients. I don't know about you all, Divas, but sometimes I can't remember what I had for dinner last night. So if that's the same with our listeners, then think about how our patients feel. If in between a six-month appointment they start a new medication and it becomes a routine after two or three months, they may forget to tell us. So it's so important to focus on that. Thank you, Olivia. So when I think of risk communication with patients, it's about being able being able to have an effective conversation with a patient. That's a two-way conversation. We have so much information that we need to share with patients while they're in our dental chair. And as a former hygienist, I can think about the fact that, you know, you wait to get your hands on that patient's mouth, and then you start going on and on about oral hygiene instructions. And we don't really know if the patient's listening or if they've tuned us out because they have dark glasses on that we put on their face. So we don't know if they're paid attention. So it's really a two-way street. It's not a monologue. We're not preaching to the patient, so we're not giving a lecture, but we're having a conversation where you actually listen to the patient and take time to respond back. And this is particularly critical in the area of obtaining an informed consent. And informed consent is much more than just a general consent to treat that new patients will sign to come in and have the exam, have some x-rays and get diagnosed. I'm speaking more about invasive procedures, particularly surgical procedures or maybe complex restorative procedures, and maybe even scaling and root planning. I know I have some clients over the years that use informed consent for that process. But the first part of an informed consent is the conversation with the patient. And that conversation and obtaining that conversation and that obtaining verbal informed consent at first is held by the doctor because only the doctor can diagnose. So the doctor is the one that holds that informed consent conversation. It does need to be documented in the patient's record. And then last but not least is the form that the patient will sign for those extractions or those implants or whatever the procedure is. Anyone in the practice can obtain a signature on a form, but it's so very important that the doctors and only the doctors deliver the diagnosis and provide the informed consent related to the risk, benefits, and alternatives of the treatment. So, Leslie, you have a thought on that?
SPEAKER_01You know, one other thing I forgot to mention, and it came to mind when you were talking about health histories and when Olivia was expressing the importance of it, at University of the Pacific, Dugoni School of Dentistry, they have the medical history forms in multiple languages. And while it may be difficult to communicate with a patient that doesn't speak English, and you likely have to have somebody interpret for them, having a health history that's accurate, that can be in their own language, is imperative. So I highly recommend that anyone has patients that speak a different language and maybe they're they speak English but not fluently and maybe not understand. And maybe the interpretation from the person that's interpreting our English health history, it'd be much better if they could see the information for themselves in their own language.
SPEAKER_00And that is so true, Leslie. Having forms available in multiple languages is very important. So knowing your patient population is extremely important so you can be able to communicate effectively. And so that way, in cases where, say, the patient doesn't speak English or English is not their first language, if you're using a translator, it's a bona fide translator, or at least someone that practices an employee or the doctor over the age of 18 that can speak that language and not a minor child. So, Davis, we've had diverse areas of patient safety, eye wear medical history, environmental realms, informed consent. I'd like to leave our listeners with the power of A as we think about the entire patient safety week. So this year the theme of patient safety revolves around the power of A. That's A as an apple. The first A is awareness. So take time to raise that awareness in yourself and in your practice for patient safety by staying abreast of what's the changes we've talked about, reading articles, attending courses. In Florida, one of our mandatory CE courses is preventing medical errors. So that continually raises our awareness. Then assessment. As a team, come together and think about the areas in your practice where there are opportunities for improvement and discuss that as a team. And then action. After you've done an assessment with the team, take time to create action items and enact that plan so you can fully implement any changes that you might need to make, no matter how minor we are holding patient lives in our hands every time that patient steps to the front door. And actually, even before, as Leslie pointed out, before they step in the front door. So thank you for joining us for this episode. As the Compliance Divas, we bring clarity and simplicity to compliance by navigating the regulatory world to keep you on track. We invite you to subscribe to our podcast through your favorite podcast channel or on our website, thecompliancedevas.com. And we have some great resources that we're going to have in the show notes for you today. And we always invite you to submit questions to support at thecompliancedevas.com. And we invite you to scroll down and leave us a like or review at the end of the podcast. And we will see you next time.