Clinical governance

Question 1

what is clinical governance?

Answer 1

the framework through which healthcare organisations are accountable for continuously improving the quality of their services and safeguarding high quality of care

Question 2

what is a ‘human factor’?

Answer 2

a physical or cognitive property of an individual or social behaviour specific to humans that may influence the functioning of technological systems

Question 3

why are human factors important?

Answer 3

80% of errors are due to human errors
assessing them is key to improving safety

Question 4

what factors can contribute to human errors?

Answer 4

stress, missing equipment, time pressures, hunger, distraction like mobiles, noises, tiredness

Question 5

what is a never event?

Answer 5

never events are patient safety incidents that are wholly preventable where guidelines or safety recommendations are available and have been implemented by healthcare providers

Question 6

examples of dentistry never events

Answer 6

wrong tooth extraction
treating wrong patient
failing to sterilise instruments
reusing disposable items
prescription of drug to a patient with a known allergy

Question 7

how to prevent never events

Answer 7

check, double check and triple check:
patient details, name, DOB, address, charting
stop before you block
ask your assist

Question 8

how do you prevent wrong tooth extraction?

Answer 8

clear tooth notation, ask patient, write it down, check several times that it is the correct patient, correct arch, correct side and count the tooth!

Question 9

what is a datix form?

Answer 9

needed when an incident occurs - to reduce future mistakes being made

Question 10

what info can be filled out on datix forms?

Answer 10

incident date and time it happened
division: dental services
NHS staff
BDH
patient or you who is affected
witness
patient details

Question 11

do you mention names on a datix form?

Answer 11

no, must be anonymised and confidential

Question 12

prescription form

Answer 12

ask nurse for access
says ‘prescription security birmingham dental hospital clinical record’ at top

Question 13

out of order form

Answer 13

dont use whatever the sign is on

Question 14

what are the 2 x-ray forms?

Answer 14

white form = sending them downstairs for radiographs
green form = for if you are the operator on the clinic

Question 15

what must you do before you take a radiograph or use the form?

Answer 15

ensure radiation risk is explained to the patient and have a justification!

Question 16

what information do you need on the x-ray forms?

Answer 16

teeth you are radiographing
clinicians name, signature and GDC number
request written, e.g., periapical or bitewing
date

Question 17

diet diary

Answer 17

for patients who are prone to tooth decay
in box near nurses station
patient should do weekday, weekend and another day to get variation and representability
can show and educate patient
food and drink

Question 18

handpiece forms

Answer 18

Handpiece stick sheet and B-braun tray sticker sheet
no sheet for supps

Question 19

clinical photography forms - what is level A or B

Answer 19

A = open publication
B = restricted education use - this is all that is needed to allow it to be used in finals
yellow form
says ‘clinical photography and graphic design’

Question 20

prosthetic labs form

Answer 20

for RPD to design denture and send to lab

Question 21

oral medicine referral form

Answer 21

clinician will guide
letters dont show student referral so check comms tab in notes
keep patient aware

Question 22

cons lab form

Answer 22

for crowns, bridges, study casts etc
says ‘conservation prescription’

Question 23

what needs to be done to all work sent to lab?

Answer 23

disinfect, take with a sticker to the lab

Question 24

do you use NHS number when record keeping?

Answer 24

no, only use RiO number

Question 25

what needs to be done to notes?

Answer 25

need to be signed off

Question 26

why is record keeping important?

Answer 26

indentification - forensic dentistry
medico-legal concerns
ensuring correct site, treatment and patient
medical history
safeguarding concerns, documenting details of concern, place of school, caregiver etc

Question 27

Treatment plan should be written in notes but copied to where?

Answer 27

treatment plan form in comms tab
add treatment items to the chart

Question 28

what should be included in notes

Answer 28

treatment plan
make clear what your intentions on the patients next visit

Question 29

what must be done with the instruments?

Answer 29

scan B-Braun/Steris labels into Carestream/R4 notes from instrument packs
return instruments and handpieces to nursing staff. dispose of all single use items and clea down dental unit

Question 30

New patient exam template

Answer 30

GDP R2 clinic: student, assist, supervising clinician
History: age, last attended, RFA, PCO
HPC: site, onset, character, radiation, associations, time course, severity

Question 31

what needs to be recorded about local anaesthetic?

Answer 31

dose of LA, type, batch number, expiry, route

Question 32

what is the dose of LA?

Answer 32

2.2ml of lidocaine

Question 33

what should be recorded about restorations?

Answer 33

surfaces, extent of caries, isolation, restorative material used including etch and bond, post-op instructions given

Question 34

what notes should be record about lab work?

Answer 34

shades agreed with patient, method for disinfection. which lab the work has been sent to

Question 35

what notes should be recorded for extraction?

Answer 35

relevant medical history, e.g., history of bisphosphonates or anticoagulants etc
LA
site of extraction and consent
instruments used
extracted intact/root removed separately
surgical/sutures/flap raised
haemostasis achieved
post-op instructions

Question 36

what needs to be recorded about radiographs?

Answer 36

type - bitewing/PA/OPG
justification
grade
teeth present
bone loss (generally mm for bitewings and % for PA)
radiolucencies indicative of caries
pathology
other

Question 37

examples of professional behaviour

Answer 37

conduct
maintaining standards
behaviour inside and out of work
doing the right well
maintaining confidence and trust

Question 38

what is professionalism?

Answer 38

a moral contract between the profession and society that is underpinned by a set of standards

Question 39

barriers to professional behaviour

Answer 39

financial debt
substance abuse
stress
fear of whistleblowing
lack of understanding
challenging team