1.9.2 The design of the patient clinical record allows for systematic audit of the contents against the requirements of these Standards C 1.18 Implementing processes to enable partnership with patients in decisions about their care, including informed consent to treatment 1.18.2 Mechanisms are in place to monitor and improve documentation of informed consent C 4.6 The clinical workforce taking an accurate medication history when a patient presents to a health service organisation, or as early as possible in the episode of care, which is then available at the point of care 4.6.1 A best possible medication history is documented for each patient C 4.7 The clinical workforce documenting the patient’s previously known adverse drug reactions on initial presentation and updating this if an adverse reaction to a medicine occurs during the episode of care 4.7.1 Known medication allergies and adverse drug reactions are documented in the patient clinical record C 4.8 The clinical workforce reviewing the patient’s current medication orders against their medication history and prescriber’s medication plan, and reconciling any discrepancies 4.8.1 Current medicines are documented and reconciled at admission and transfer of care between healthcare settings N/A 4.14 Developing a medication management plan in partnership with patients and carers 4.14.1 An agreed medication management plan is documented and available in the patient’s clinical record N/A 7: Summary of actions that require data collection for audit or review This table identifies which of the NSQHS Standards require clinical audits to be undertaken by dental practices or services. KEY: C= Core action D= Developmental action N/A= Non applicable C/D 1.7.1 Agreed and documented clinical guidelines and/or pathways are available to the clinical workforce C
1.7 Developing and/or applying clinical guidelines or pathways that are supported by the best available evidence 1.7.2 The use of agreed clinical guidelines by the clinical workforce is monitored C 1.10 Implementing a system that determines and regularly reviews the roles, responsibilities, accountabilities and scope of practice for the clinical workforce 1.10.2 Mechanisms are in place to monitor that the clinical workforce are working within their agreed scope of practice C 1.18 Implementing processes to enable partnership with patients in decisions about their care, including informed consent to treatment 1.18.2 Mechanisms are in place to monitor and improve documentation of informed consent C 3.5 Developing, implementing and auditing a hand hygiene program consistent with the current national hand hygiene initiative 3.5.1 Workforce compliance with current national hand hygiene guidelines is regularly audited C 3.10 Developing and implementing protocols for aseptic technique 3.10.2 Compliance with aseptic technique is regularly audited D 3.11 Implementing systems for using standard precautions and transmission-based precautions 3.11.2 Compliance with standard precautions is monitored C 3.11.4 Compliance with transmission-based precautions is monitored C 3.14 Developing, implementing and regularly reviewing the effectiveness of the antimicrobial stewardship system 3.14.3 Monitoring of antimicrobial usage and resistance is undertaken N/A 3.15 Using risk management principles to implement systems that maintain a clean and hygienic environment for patients and healthcare workers 3.15.3 An established environmental cleaning schedule is in place and environmental cleaning audits are undertaken regularly C 3.17 Implementing systems to enable the identification of patients on whom the reusable medical devices have been used 3.17.1 A traceability system that identifies patients who have a procedure using sterile reusable medical instruments and devices is in place C 4.2 Undertaking a regular, comprehensive assessment of medication use systems to identify risks to patient 4.2.1 The medication management system is regularly assessed C
Individuals with delegated responsibilities are supported to understand and perform their roles and responsibilities, in particular to meet the requirements of these Standards Reflective questions Suggested strategies Evidence examples How do we support each dental team member to understand and perform their roles and responsibilities? Practice owners, senior dentists or the dental service executive are responsible for providing support to dental team members in understanding any delegated responsibilities for safety and quality. Orientation and ongoing training and education in safety and quality should develop dental team members’ skills in providing safe, high quality care. Examples of safety and quality training include: the individual with responsibility for infection control has received formal training in the cleaning, reprocessing and disinfection of reusable medical instruments dental team members have undertaken education in relation to privacy principles and patient identification dental practitioners and other team members who provide care have received first aid or basic life support training, as required all dental team members are aware of their role in an emergency relevant dental team members are educated in the principles of: infection prevention and control medication safety patient identification and procedure matching clinical handover. Orientation manual or training documentation outlining roles and responsibilities of dental team members in relation to safety and quality Access to printed or electronic safety and quality resources for dental team members Training attendance records or education resources for dental practice owners, senior dentists or the dental service executive on their safety and quality and clinical governance responsibilities Training attendance records or education resources for dental team members in the areas of: infection prevention and control medication safety patient identification and procedure matching clinical handover Other: Agency or locum workforce are aware of their designated roles and responsibilities Reflective questions Suggested strategies Evidence examples
What actions do we take to reduce safety and improve the quality of care for our patients? The risk register described in Action 1.5.1 will inform the actions to reduce risks to patient safety and quality of care. From a review of the risk register, you can identify areas where improvements are needed. You should document the agreed action to be taken, by developing a plan or amending policies, procedures or protocols. You should communicate to dental team members the results of a review of the risk register, and educate them about any new plans or initiatives, and any changes to policies, procedures and protocols. You should also monitor the implementation of any new plans or initiatives, or revised policies, procedures or protocols. Examples of actions to minimise the safety and quality risks could include: the purchase of a more effective instrument washer/disinfector to reduce infection risks the use of rubber dams during dental procedures, which is likely to reduce the risk of patients inhaling or swallowing burrs that may accidently break during procedures. Agenda minutes or other records of meetings where reviews of the risk register are discussed Examples of improvement activities undertaken to address risks documented in the risk register Results of risk assessments to identify areas of priority for action Action plan or list of actions to address issues or risks identified on the risk register Other: Establishing an organisation-wide quality management system that monitors and reports on the safety and quality of patient care and informs changes in practice An organisation-wide quality management system is used and regularly monitored Reflective questions Suggested strategies Evidence examples How do we plan our work and measure our success to make improvements? How do we use quality management methods in our dental practice? A quality management system will provide a framework to improve the efficiency and effectiveness of your practice. As a first step in implementing a quality management system you should define the elements of ‘quality’ for your practice, for example, effectiveness, safety and patient experience. The vision, values and Schedule of regular reviews and reports submitted to the practice owners, senior dentists or dental service executive Action plan or list of quality improvement activities to be undertaken by the dental practice Quality framework or quality improvement plan Practice quality/operational plan
developing a plan or amending policies, procedures and protocols. You should communicate to team members the areas where improvements are needed, and educate them about any new plans or initiatives, and any changes to policies, procedures and protocols. You should monitor the implementation of any new plans, initiatives or revised policies, procedures and protocols. For a small dental practice, to maximise quality of care, you may consider maintaining a list or register of the quality activities you have implemented and their results. For a dental practice or service, you may use key performance indicators for safety and quality of care developed by the safety and quality committee, with a record of the actions you have taken to improve the quality of care. A register of quality improvement activities that are planned or have been implemented in response to monitoring Quality improvement plan with timeframes and responsibilities for improvement activities Examples of improvement activities undertaken to address areas requiring action Agenda items, minutes or other records of meetings where quality activities are discussed Other: practice Care provided by the clinical workforce is guided by current best practice. Developing and/or applying clinical guidelines or pathways that are supported by the best available evidence Agreed and documented clinical guidelines and/or pathways are available to the clinical workforce Reflective questions Suggested strategies Evidence examples Which clinical guidelines do we use, where do they come from and how do our dental team members access them? You should identify clinical guidelines and pathways, consult with relevant members of the dental team and adopt those that are most relevant to the care provided in the practice. You should also ensure that the clinical guidelines are current and accessible to all who need to use them. Policies, procedures or protocols that outline the use of clinical guidelines by dental practitioners and other team members providing care Access to printed or electronic copies of clinical guidelines for dental practitioners and other team members providing care Other:
How do we make patient dental records available to dental practitioners and other team members when care is provided? How do we know our patient dental records are comprehensive and accurate? As part of a comprehensive dental record system, you should have electronic or based patient dental records available where dental care or treatment is provided. The patient’s dental record should be available to the dental practitioner or other team members providing care in the treatment room so that all aspects of dental care can be documented, including: medical history correspondence from other healthcare professionals examination and test results radiographs photographs treatment options treatment plan the informed consent process. You should use standard abbreviations to ensure that other members of the dental team can understand patient dental records. Standardised templates or forms for patient dental records, either electronic or paper based List of agreed standard abbreviations used by dental practitioners and other team members providing care Policy, procedure or protocols for filing investigation results and clinical correspondence in the dental record system System for the retrieval of current and archived patient dental records Audit of availability of the patient dental record at the time it is required for use by the dental practitioner or other team member providing care Other: The design of the patient clinical record allows for systematic audit of the contents against the requirements of these Standards Reflective questions Suggested strategies Evidence examples How do we know our patient dental records are meeting the key requirements of standards? You should ensure that: the patient’s dental record is designed so as to allow the logical flow of information about the treatment and care provided the flow of the information in the history is ordered so that an external or inspection can easily follow the actions of the dental practitioner or other team member providing care during the examination and treatment phases the record is completed and recorded in a consistent manner by the dental practitioners working within the dental practice Results of dental record keeping audits Evidence of changes to the patient dental record system that improves its auditability for clinical information List of agreed standard abbreviations used by dental practitioners and team members providing care Other:
Reflective questions Suggested strategies Evidence examples What access do team members have to education and training in safe practice and good quality of care? Your dental practice should have an education program which: supports the services and care provided addresses team members’ responsibilities for safety and quality. For example, all team members with responsibility for patient dental record keeping should have some education on the requirements for confidentiality and privacy. You can provide training at orientation, as part of the supervised delivery of care, during informal tutorial and training sessions, or at external courses and programs of education. Policy, procedure or protocol that describes access to ongoing education and training for dental team members Orientation manual or training documentation for new dental team members outlining access to ongoing education and training Evidence of dental team members’ participation in patient safety and quality education programs or continuing professional development (CPD), such as attendance certificates or professional registration records Other: Seeking regular feedback from the workforce to assess their level of engagement with, and understanding of, the safety and quality system of the organisation Analyse feedback from the workforce on their understanding and use of safety and quality systems Reflective questions Suggested strategies Evidence examples How do we obtain feedback from dental team members on safety and quality matters to review their understanding and use of our processes? You should consider the different ways in which you could collect information from dental team members about their understanding and use of the practice’s safety and quality systems. This may take the form of: discussions in team meetings questions during performance reviews which can then be deidentified and aggregated a survey of dental team members. Survey results of dental team members’ knowledge of safety and quality systems Agenda items, minutes or other records of meeting about safety and quality systems Other: Action is taken to increase workforce understanding and use of safety and quality systems Reflective questions Suggested strategies Evidence examples
how and when incidents and near misses should be recorded who is responsible for investigating and responding to the incident the timeframes for completing the investigation and implementing any required changes or improvements. In a small dental practice, this may be a simple system where: team members record the details of an incident the practice manager starts an investigation the results of the investigation are recorded and analysed any actions taken are documented and communicated to team members. In a large dental practice or service, you may have electronic incident management systems which allow for tracking of the investigation and response times as well as categorisation and analysis of incidents. Practice owners, senior dentists or the dental service executive should ensure that team members are trained on what constitutes a clinical incident (and other incidents) and a near miss and the process for reporting. You should encourage them to report incidents. You should arrange for this training to be provided to team members at the time of induction, and for their knowledge to be checked regularly. Orientation manual or training documentation for dental team members outlining processes for documenting incidents Action plan or list of actions to address relating to incidents reported in the incident management system Other: Systems are in to analyse and report on incidents Reflective questions Suggested strategies Evidence examples What is our process for reviewing information on incidents and near misses? Every practice should have a designated team member responsible for coordinating the analysis of clinical and non-clinical incidents and near misses and reporting Reports generated from the incident reporting system Reports analysing incident trends or types
rights and engagement Patient rights are respected and their engagement in their care is supported. Implementing through organisational policies and practices a patient charter of rights that is consistent with the current national charter of healthcare rights The organisation has a charter of patient rights that is consistent with the current national charter of healthcare rights Reflective questions Suggested strategies Evidence examples How do we align our approach to patient healthcare rights with the Australian Charter of Healthcare Rights46? The Australian Charter of Healthcare Rights46 defines rights to access, safety, respect, communication, participation, privacy and comment. Dental practices should adopt or develop a charter of patient’s healthcare rights, which is consistent with the Australian Charter of Healthcare Rights.46 Charter of patient’s healthcare rights used in the practice which is consistent with the Australian Charter of Healthcare Rights46 Policy, procedure or protocol outlining the use and distribution of the charter Other: Information on patient rights is provided and explained to patients and carers Reflective questions Suggested strategies Evidence examples How do we communicate to patients information about their healthcare rights? Dental practices should ensure that all patients are provided with the charter of patient’s healthcare rights when they first attend the practice and that it is easily accessible to patients at other times. Examples on how this can be achieved could include: the charter for patient’s healthcare rights is prominently displayed throughout waiting area and clinical areas the practice provides a copy of the charter of patient’s healthcare rights when patients present for an appointment. Ask patients to read the document and consult with dental team members if they do not understand or if they wish to have anything clarified for them copies of the charter are readily accessible to all patients and carers who access services from the practice. Policy, procedure or protocol outlining the use and distribution of the charter of patient’s healthcare rights Training attendance records or education resources for dental team members the charter of patient’s healthcare rights Orientation manual or training documentation for dental team members outlining processes for the distribution of the charter of patient’s healthcare rights Charter of patient’s healthcare rights displayed in waiting areas or material is readily accessible
Mechanisms are in place to monitor and improve documentation of informed consent Reflective questions Suggested strategies Evidence examples How do we know our patient and consent documentation and processes are applied correctly? How do we improve our patient and carer consent documentation and processes? ‘Informed consent’ is a person’s voluntary decision about health care that is made with knowledge and understanding of the benefits and risks involved.32 The National Health and Medical Research Council (NHMRC) has published a useful guide to the information that practitioners need to give to patients, General guidelines for medical practitioners in providing information to patients.48 Dental practices should have policies, procedures or protocols for obtaining and documenting the patient’s informed consent to treatment. The documentation should meet and ethical requirements such as the Health Practitioner Regulation National Law Act 200949 and the Dental Board of Australia’s Code of conduct.32 You can use a review of patient dental records to measure compliance with the informed consent process. Policy, procedure or protocol for obtaining patient consent to treatment Patient and carer information packages and consent forms or templates Review of patient dental records for documentation of the informed consent process Other: Mechanisms are in place to align the information provided to patients with their capacity to understand Reflective questions Suggested strategies Evidence examples How do we provide information about treatment options and risks to patients? How do we take into account a patient’s ability to understand the information? If you use publications that have been developed externally, for example by or territory health departments, you should try to source information that has been developed with input from consumers. If you are developing patient information publications locally, you can obtain and document feedback from consumers about the publications by: discussing publications with consumers in waiting areas holding a focus group or workshop with consumers Patient or carer information sheets or resources available in a range of languages and formats, consistent with the patient profile Feedback from patients and carers regarding information material and the consent process Other:
reflect the diversity of our patient population? You can find out about the demographics of your patient population from a number of sources, including: a patient experience survey with questions included to help identify the diverse groups of patient who access services collecting information about patients’ diverse backgrounds through the patient enrolment form. Using this information, you can then implement strategies to engage with consumers who reflect the diverse range of patients who attend your practice. Approaches to doing this can range from formal activities such as including consumers on boards or committees, to informal strategies such as holding a lunchtime consumer session and engaging in conversations in the waiting area. It is important to consider consumers from culturally and linguistically diverse backgrounds and those with a lower level of health literacy. Evidence that feedback is sought from a broad range of consumers, for example criteria for the selection of consumer representatives Records of consultation with patients from vulnerable groups to seek feedback improving their dental experience Other:
Consumers and/or carers are actively involved in decision making about safety and quality Reflective questions Suggested strategies Evidence examples How do consumers participate in decision making for safety and quality? Consumers can add value to decision making about safety and quality by asking questions about service provision and suggesting improvements. This is most effective when a systematic approach is taken. You can involve consumers in: reviews to identify safety and quality issues within the practice, such as unclear signage the planning and implementation of a new procedure such as a new injection system. Agenda items, minutes or other records of meetings where consumer representatives have been present and safety and quality issues discussed Documentation of improvement activities that have been initiated as a result of suggestions arising from consumers: on committees through the complaints or compliments system as part of patient experience surveys using other forms of feedback mechanisms Records of consumer involvement in reviews to identify safety and quality issues Records of consumer involvement in workplace health and safety checks Records of discussions with consumers in the waiting room or reception area about projects and opportunities for improving services Other: Clinical scenario: A consumer engagement plan As part of a broader policy on stakeholder engagement, an oral health service developed a consumer engagement plan for the work unit. This plan contained procedures and protocols to describe the steps that the work unit would take to involve consumers in the oral health service’s clinical and operational management. The plan set out processes for: training team members in engaging with consumers, including team meetings and structured peer discussion sessions focused around point-of-care patient surveys and consumer engagement. Applying the NSQHS Standards:
You may also use monitoring undertaken as part of Actions 3.1.2, 3.2.2, 3.8.1, 3.10.2, 3.11.2, 3.11.4, 3.14.3 and 3.16.1 to meet this action. The effectiveness of changes to practice are evaluated Reflective questions Suggested strategies Evidence examples How do we know if changes to our policies, procedures or protocols have improved patient outcomes? Evaluation is a key component of a quality improvement approach. After determining any change made to practice in Action 3.4.2, you will want to know if the change is an improvement. You can measure effectiveness through: monitoring how dental team members comply with policies, procedures or protocols conducting dental team meetings to discuss how changes are implemented. Results of a review of the dental practices incident register and incident reports to demonstrate changes, trends and improvements Evaluation of reports of any possible healthcare associated infection adverse events over time. These could include: infections identified following a dental procedure or treatment any allergic responses to treatment (for example, antibiotics) reported occupational exposures or incidents of any possible communicable infections that involve the dental practice Analysis of the practice risk management plan to identify how have been responded to, and if the response has been successful and sustained Other: prevention and control strategies Strategies for the prevention and control of healthcare associated infections are developed and implemented. Developing, implementing and auditing a hand hygiene program consistent with the current national hand hygiene initiative
Is our immunisation program consistent with the national immunisation guidelines? Practice owners, senior dentists or the dental service executive should have a program to minimise the risk of exposure of both dental team members and patients to specific vaccine preventable infections. An immunisation program should include: a record of each dental team member’s immunisation status a policy based on the Australian Immunisation Handbook53 and any state or territory health department requirements a statement of and how these risks are to be managed details of the information provided to dental team members about: immunisation and relevant vaccine preventable diseases how the practice manages vaccination refusal, for example managing the risk of a dental team member transmitting disease to vulnerable patients what will happen if a dental team member refuses reasonable requests for vaccination reference to infection prevention and control practices information on the process for reviewing and maintaining the immunisation program a record of: advice provided to dental team members dental team members who refuse requests to be vaccinated. Policies or procedures (or contracts) describing the requirements for immunisation for both new and existing team members against specific vaccine preventable infections Immunisation register with information on: all team members employed the date that each team member commenced employment the immunisation status of each team member whether or not a letter from a qualified health professional is held on file for each team member, stating that they have been immunised as required for the type of work they do Other:
Compliance with aseptic technique is regularly audited Reflective questions Suggested strategies Evidence examples How do we find out if our dental practitioners and team members providing care routinely follow aseptic technique when required? You should review the use of aseptic technique by dental practitioners’ and other team members providing care, to help determine the factors that improve compliance. Once you have identified the areas where aseptic technique is required, you should assess how the principles are applied. To do this you can audit the practice of the dental practitioners and identify where gaps in practice exist. The extent and frequency of auditing the compliance with aseptic technique will be influenced by: identified gaps in practice of aseptic technique the clinical context where care is provided the frequency with which aseptic technique is required the treatment provided when aseptic technique was last assessed results of previous compliance audits. Audits of compliance with aseptic technique Other: Action is taken to increase compliance with aseptic technique protocols Reflective questions Suggested strategies Evidence examples What action have we to improve dental team compliance with aseptic technique? The aim of aseptic technique protocols is to prevent or minimise the risk of introducing harmful infectious agents into susceptible of the body. The intent of this action is to increase compliance with these protocols by dental practitioners and other team members who provide care. Review of policies, procedures and protocols to ensure they reflect principles of aseptic technique where relevant, and are current and applicable Records of agenda items, minutes or meetings where reports of aseptic technique compliance are reviewed and efforts to increase compliance are discussed
What action have we to improve the use of standard precautions by our team? An understanding of dental team members’ use of standard precautions will help to determine any areas where improvements are needed. First you should identify gaps or risks in the dental practice where improvement may be needed. Next you should act to address these gaps or risks and monitor improvements. with Action 3.1.4 in relation to improvement actions. List of actions or an action plan to address issues or risks related to standard precautions Examples of improvement activities undertaken to improve compliance with standard precautions Training attendance records or education resources for team members about infection prevention and control Other: Compliance with transmission-based precautions is monitored Reflective questions Suggested strategies Evidence examples How do we find out if our team correctly follows precautions? Dental team members should know when and how to transmission-based precautions to minimise infection risk. It is necessary to maintain a safe work environment for dental team members and patients and carers. You should use the information from risk registers and the results of auditing conducted in the practice to assist. The gap and risk assessments undertaken for standard precautions will show areas for improvement with transmission-based precautions. Audit results on dental team members’ compliance with the elements of transmission-based precautions and associated safe work practices A risk register in line with Action 1.5.1 and list of actions to mitigate identified Communication material and signage for patients and carers as well as visitors and dental team members on instructions for transmission-based precautions Training attendance records or education resources for dental team members on safe work practices relating to transmission-based precautions based
The clinical team prescribing antimicrobials have access to current endorsed therapeutic guidelines on antibiotic usage Reflective questions Suggested strategies Evidence examples In what ways is access provided to current endorsed therapeutic guidelines for dental practitioners who prescribe antibiotics? You should ensure that dental practitioners have access to current endorsed Australian therapeutic guidelines and resources on antimicrobial prescribing such as the Therapeutic Guidelines: Antibiotic50 and the Therapeutic Guidelines: Oral and Dental51 or endorsed guidelines on antibiotic usage. If possible, you should use resources that have been developed: in your dental practice or service, or at a corporate level across a number of dental practices, or as part of a health service organisation, state or territory professional bodies. You should ensure there is version control of prescribing guidelines so that dental practitioners are aware they are using the most up-to-date version available. All dental practitioners have access to printed or electronic copies of current endorsed Australian therapeutic guidelines and resources on antimicrobial prescribing such as the Therapeutic Guidelines: Antibiotic50 and the Therapeutic Guidelines: Oral and Dental51 Locally adapted guidelines are consistent with current endorsed Australian therapeutic guidelines and resources on antimicrobial prescribing Other:
Reflective questions Suggested strategies Evidence examples Are our policies, procedures and protocols consistent with regulations and national guidelines with regard to medicine: ordering storing prescribing administering supplying disposal? How do we ensure documents are updated and available for use by our team? The practice policies, procedures and protocols for medication management should be based on best practice, national guidelines and legislative requirements. They should support team members to meet the requirements of the relevant legislation and standards to ensure safe practices. Policies, procedures and protocols for medication management may include: prescribing guidelines use of approved abbreviations when prescribing medicines administering guidelines for the administration of medicines, including high-risk medicines such as intravenous (IV) sedation checking patient identification prior to prescribing, supplying or administering medicines (see NSQHS Standard 5: Patient Identification and Procedure Matching) managing high-risk medicines (see Item 4.11) policies and procedures for services provided by external providers. You should have a process for reviewing and updating policies, procedures or protocols to ensure that they: are up to date address current and relevant regulations and guidelines are available to all team members. Policy, procedure or protocol describing the correct manner in which to supply, store, administer, prescribe, dispense, monitor and dispose of medicines A register of approved medication policies, procedures or protocols and a schedule outlining their next review date Other:
You should incorporate the actions to be taken in either: a quality improvement plan that assigns responsibilities and timeframes for completion, or revised policies, procedures or protocols. You should with team members the results of the assessment in Action 4.2.1 and any actions taken. You should organise training for team members in the new initiatives or processes. Links with Action 4.5.2. Authorising the relevant clinical team to prescribe, dispense and administer medications A system is in place to verify that the clinical workforce have medication authorities appropriate to their scope of practice Reflective questions Suggested strategies Evidence examples How does our organisation ensure that only dental practitioners with the relevant authority prescribe, dispense or administer medicines? This action requires a system whereby dental practitioners are authorised to prescribe, dispense or administer medicines, including the supply of medicines. First, you should identify medicines that require specific authorisation to prescribe, dispense or administer medicines, including the supply of medicines. Next you can develop and maintain a log or register of authorisations of dental practitioners who may prescribe, dispense, administer and supply medicine. In a small dental practice, these authorities may be detailed in the position descriptions. Log or register of relevant authorities for prescribing, administering and supplying of medicines Position descriptions which outline each dental practitioner’s prescribing authority Records of dental practitioners’ authorised prescriber numbers, AHPRA registration number and annual AHPRA registration checks for any conditions Other:
Reflective questions Suggested strategies Evidence examples How do we know that our decision support tools are current and of use to our dental practitioners? The dental practice should have a process to review the currency and endorsement of medication information resources and decision support tools. This could include: nominating a dental team member with responsibility for monitoring currency of resources establishing mechanisms to ensure that updates or new versions are installed. In a large dental practice or service, consider if you need to: include clinical support functionality when implementing electronic medication management systems, for example for e-prescribing the use of medication information resources and decision support tools by dental practitioners. This could include a survey of dental practitioners’ knowledge of how to access the resources obtain feedback about content and usefulness of resources. Access to printed or electronic copies of medication information or decision support tools such as the Therapeutic Guidelines: Antibiotic50 and Therapeutic Guidelines: Oral and Dental51, and MIMS Observational audit of decision support resources available to dental practitioners at the point of care A formal review of all the decision support tools within the practice Results of surveys of dental practitioners Agenda items, minutes or other records of meetings where updates to medication resources are discussed Other: Action is taken to improve the availability and effectiveness of information and decision support tools Reflective questions Suggested strategies Evidence examples What action do we take to improve access to, and use of, medicines information resources and decision support Following the review undertaken in Action 4.9.2, you should now take action to improve the use of clinical information and decision support tools. You should: A quality improvement plan in line with Action 1.6.1 that includes actions to improve access to medication information resources and decision support tools
Are our medicine disposal processes consistent with jurisdictional requirements and the manufacturer’s recommendations? This action requires policies, procedures or protocols for the disposal of unused, unwanted or expired medicines be implemented. You should have a process for: checking stock expiry dates to ensure that expired medicines cannot be inadvertently used minimising unused, unwanted and expired medicines by monitoring levels and rotating stock. You should also have procedures for the safe disposal of unwanted or expired medicines. These must comply with manufacturer’s recommendations, and legislative and jurisdictional requirements. Records of checks for expired Evidence of regular stock monitoring and stock rotation Log of unused, unwanted and expired medicines that required disposal, and the method by which medicines have been disposed Policies, procedures or protocols documenting processes for the disposal of unused, unwanted or expired medicines that with legislative and jurisdictional requirements Position description detailing responsibility for disposal of medicines for a nominated team member Other: The system for disposal of unused, unwanted or expired medications is regularly monitored Reflective questions Suggested strategies Evidence examples How do we know if our dental team members are using the processes for the disposal of medicines? You should audit the processes and practices for the disposal of expired and unwanted medicines on a scheduled basis. Next, you should report findings to the owner or senior dentist (for a small dental practice) or the relevant committee meetings (for a large dental practice or service), then share outcomes with team members. Report and investigate incidents related to unwanted or expired medicines. of the disposal of unused, unwanted and expired medicines and the appropriateness of the disposal method A risk register in line with Action 1.5.1 that includes actions to address identified with the disposal of unused, unwanted or expired medications Agenda items, minutes or other records of meetings where medication disposal audit findings or identified risks are tabled and discussed Other: Action is taken to increase compliance with the system for storage, distribution and disposal of medications Reflective questions Suggested strategies Evidence examples
The dental practice should source or develop the required patient brochures or fact sheets, including consumer medicines information. You should record medicines information distributed to a patient, in their dental record. You could establish referral systems with a local pharmacist to inform patients about the medicines prescribed. Alternatively, the dental practitioner can print on the prescription a request for the pharmacist to supply the patient with this information. Patient education material such as fact sheets, brochures, or to trusted web sites Observational audit of dental practitioner’s access to patient medication information and materials at the point of care Examples of prescriptions including a request for the pharmacist to supply medicines information Other: Developing a medication management plan in partnership with patients and carers An agreed medication management plan is documented and available in the patient’s dental record Non-applicable for dental practices Providing current medicines information to patients in a format that meets their needs whenever new medicines are prescribed or dispensed Information on medicines is provided to patients and carers in a format that is understood and meaningful Action is taken in response to patient feedback to improve medicines information distributed by the health service organisation to patients Non-applicable for dental practices Clinical scenario: Use of medicines A dentist at a busy inner city dental practice treated Omar, a walk-in client with a facial swelling. The dentist had decided to see Omar in between his regular appointments because of the urgent nature of the condition. The dentist noted that English was Omar’s second language, but Omar spoke fluently and the dentist was satisfied that Omar was able to understand and give consent for the procedure. Communicating with clients about the expected benefits, risks and options for medicines, including the risks of not taking the medicine. ‘Establishing the risks of treatment’ was determined to include taking a full medical history and questioning regarding allergies, using general questions such as, ‘Are you allergic to anything?’ and ‘Have you taken this medication before?’ The patient information chart was
Appendix: Decision support tool This decision support tool has been developed as general guidance for dental practices and services undertaking self-assessment. It lists common actions within and across the Standards and describes satisfactory and unsatisfactory performance. Policies, procedures and/or protocols are in use Documents detail the date they become effective and the date they are due for revision. Source documents are referenced, particularly they are represented as best practice. Documents may reference the consultation processes undertaken or collaborative group involved in their development. Documents are adapted to the specific context and setting in which they are used by the dental practice. Team members know the documents exist, can access them, and know and use the contents. Documentation is: out-dated incomplete either overly complex and detailed or lacking in specificity not related to the practice, for example policy developed by another organisation or body and not adapted for use by the dental practice not accessible or unknown to Monitor and report Data sampling or collection occurs across the dental practice. Quality of data is known. Processes exist to test and improve the quality of the data. Feedback is provided to targeted and is available across the dental practice. Data presented in reports is meaningful and relevant. Data collection and reporting informs a problem area or an area of specific risk. Timeliness of the collection and review of the data is consistent with the being examined. Data is not sufficiently proximal to the issue being examined to provide meaningful information. No feedback is provided or the feedback provided is not sufficiently specific to be of use. Feedback is not available to individuals, team members, governance committees or areas that can make improvements. Data is not sufficiently recent to be relevant to the current provisioning of service. Action is taken to improve The action being taken: is applicable broadly across the dental practice Action claims to be organisation-wide, but relates to a localised process or situation and there is no clear
Australian Medicines Handbook. Adelaide: Australian Medicines Handbook Pty Ltd; 2015. Australian Commission on Safety and Quality in Health Care. National Recommendations for User-applied Labelling of Injectable Medicines, Fluids and Lines. Sydney: ACSQHC; 2012. Department of Health. Quality use of medicines. [Internet] Canberra: Australian Government Department of Health; 16 July 2015]; Available from: . Australian Commission on Safety and Quality in Health Care. Ensuring Correct Patient, Correct Site, Correct Procedure Protocol for clinical areas. [Internet]: ACSQHC [cited 16 July 2015]; Available from: Australian Commission on Safety and Quality in Health Care. Implementation toolkit for clinical handover improvement. Sydney: ACSQHC; 2011. Dental Board of Australia. Scope of practice registration standard. [Internet]: Dental Board of Australia; 2014 [cited 16 July 2015]; Available from: . Australian Commission on Safety and Quality in Health Care. The OSSIE Guide to Clinical Handover Improvement. Sydney: ACSQHC; 2010.