Minyé HM, Benjamin EM. Br Dent J. 2022;232:879-885.
High reliability organization (HRO) principles used in other high-risk industries (such as aviation) can be applied patient safety. This article provides an overview of how HRO principles (preoccupation with failure, situational awareness, reluctance to simplify, deference to expertise, and commitment to resilience) can be successfully applied in dentistry.
Yansane A, Tokede O, Walji MF, et al. J Patient Saf. 2021;17:e1050-e1056.
Clinician burnout is a known threat to patient safety. This survey of a national sample of dentists found that approximately 1 in 10 respondents reported high levels of burnout and 50% of respondents reported a perceived dental error in the last 6 months. Efforts to minimize burnout among dentists may help improve patient safety.
Weenink J-W, Wallenburg I, Leistikow I, et al. BMJ Qual Saf. 2021;30:804-811.
This qualitative study explored the impact of published inspection frameworks on quality and safety in nursing home care, dental care, and hospital care. Respondents noted the importance of the inspection framework design, the role of existing institutional frameworks, and how the frameworks can influence quality improvement across various organizational levels.
Chua K-P, Brummett CM, Conti RM, et al. Pediatrics. 2021;148:e2021051539.
Despite public policies and guidelines to reduce opioid prescribing, providers continue to overprescribe these medications to children, adolescents, and young adults. In this analysis of US retail pharmacy data, 3.5% of US children and young adults were dispensed at least one opioid prescription; nearly half of those included at least one factor indicating they were high risk. Consistent with prior research, dentists and surgeons were the most frequent prescribers, writing 61% of all opiate prescriptions.
Bailey E, Dungarwalla M. Prim Dent J. 2021;10:89-95.
Research into patient safety culture in primary dental care remains limited. This commentary provides an overview of patient safety in dentistry and tools to develop a robust patient safety culture, including human factors and supporting second victims.
Coulthard P, Thomson P, Dave M, et al. Br Dent J. 2020;229:743-747; 801-805.
The COVID-19 pandemic suspended routine dental care. This two-part series discusses the clinical challenges facing the provision of routine dental care during the pandemic (Part 1) and the medical, legal, and economic consequences of withholding or delaying dental care (Part 2).
Obadan-Udoh E, Panwar S, Yansane A-I, et al. J Evid Based Dent Pract. 2020;20:101424.
Patient safety events are common in dentistry. A survey administered to adult dental patients found that a majority of them were concerned about their safety at the dental office but that those concerns were not routinely shared with dental providers or clinic staff. Efforts to improve patient engagement and speaking up behaviors can improve safety in dentistry.
Brown KW, Carlisle K, Raman SR, et al. Health Aff (Milwood). 2020;39:1737-1742.
Over the last decade, children have experienced a dramatic rise in hospitalizations and intensive care unit stays related to opioid use. Based on Medicaid claims in North Carolina, prescribers of opioids for children were most commonly physicians and dentists. More than 3% of children ages 1 to 17 years had at least one opioid prescription filled annually; 76.6 children per 100,000 experienced an opioid-related adverse event or other harm. Adolescents ages 15 to 17 years disproportionately experienced these harms compared to younger age groups. Black and urban children were less likely to fill opioid prescriptions or experience adverse events, but they were more likely to experience other opioid-related harm, such as abuse or dependence.
Zhou J, Calip GS, Rowan S, et al. Pharmacotherapy. 2020;40:992-1001.
This study analyzed the association between potentially inappropriate prescribing involving opioids prescribed by dentists and emergency department visits and hospitalizations among older patients. Results indicated that a significant proportion of older patients prescribed opioids by their dentist have contraindications (such as psychotropic medication use) which places them at increased risk for 30-day hospitalizations.
This study reviewed adverse event reporting forms from 16 dental schools and found that the forms were not standardized in structure, organization, or content. Adoption of a standardized method for event collection and assessment would allow for quality improvement and increase patient safety.
This two-part series discusses anesthesia- and sedation-related medication errors and adverse events in healthcare and dentistry (part 1) and how these errors impact dentistry and approaches to address these issues within a dental anesthesia medication safety paradigm - the Dental Anesthesia Medication Safety Paradigm (DAMSP) - which offers four general guidelines for reducing anesthesia medication errors and adverse drug events in dentistry (part 2).
Perea-Pérez B, Labajo-González E, Acosta-Gío AE, et al. J Patient Saf. 2020;16.
Based on malpractice claims data in Spain, the authors propose eleven recommendations to mitigate preventable adverse events in dentistry. These recommendations include developing a culture of safety, improving the quality of clinical records, safe prescribing practices, using checklists in oral surgical procedures, and having an action plan for life-threatening emergencies in the dental clinic.
Farooqi OA, Bruhn WE, Lecholop MK, et al. Int J Oral Maxillofac Surg. 2020;49:397-402.
The over-prescribing of opioids is a recognized contributor to patient harm. This multidisciplinary panel developed six recommendations to manage pain after dental procedures while reducing harm to patients:
(1) Offer alternatives to opioids after dental surgery to interested patients when clinically appropriate.
(2) Avoid prescribing opioids after dental surgery if pain is comfortably management with over-the-counter medication.
(3) Advise patients about non-pharmacological therapies (e.g., cold, heat, distraction).
(4) Teach patients to maximize non-narcotic (over the counter) pain medication with scheduled dosing unless contraindicated.
(5) Engage in shared decision-making with patients.
(6) Consider factors such as medical contraindications, risk for addiction, and risk aversion when prescribing opioids.
Suda KJ, Zhou J, Rowan SA, et al. Am J Prev Med. 2020;58:473-486.
National guidelines published in 2016 recommend prescribing low-dose opioids for short durations when necessary, including in dentistry practices. This cross-sectional analysis of over 500,000 commercial dental patients over a five-year period (2011-2015) examined prescribing practices prior to the recommendations and found that 29% of prescribed opioids exceeded the recommended dose for management of acute pain and half (53%) exceeded the recommended days’ supply. The authors emphasize the importance of evidence-based interventions tailored to dentistry to curtail excessive opioid prescribing.
Walji MF, Yansane A, Hebballi NB, et al. JDR Clin Trans Res. 2020;5:271-277.
Building upon prior research developing trigger tools for identifying preventable errors in dentistry, this study reviewed 1,885 electronic health records (EHR) across four dental practices and found that 16% contained an adverse event. The most common events were pain (27.5%), hard tissue (14.8%) or soft tissue injuries (14.8%) and nerve injuries (13.3%). An EHR-based trigger tool can be an effective approach to identifying safety incidents and measuring the quality of care.
Graham C, Reid S, Lord TC, et al. Br Dent J. 2019;226:32-38.
Reporting and avoidance of “never events,” such as a wrong tooth extraction, is important for providing consistently safe dental care. This article describes changes made in safety procedures, including introducing surgical safety briefings or huddles in an outpatient oral surgery unit of the United Kingdom’s National Health Service, that eliminated never events for more than two years.
Cheng H-C, Yen AM-F, Lee Y-H. J Dent Sci. 2019;14:263-268.
Patient safety events are common in dentistry, but it has been challenging for dental healthcare workers to establish a robust patient safety culture. This study used a cross-sectional survey to assess the safety attitudes among dentists and dental hygienists. Safety attitudes were high overall, but attitudes differed significantly by dentist characteristics. A 2016 Perspective on Safety in Dentistry offers more background on this topic.
Assumptions, communication barriers, and implicit biases can compromise the care of patients with disabilities. This commentary discusses the presence of diagnostic overshadowing when providing dental services to patients with learning disabilities. The authors provide indications of pain and other behaviors clinicians should recognize to help with diagnosing conditions in this vulnerable population.
This retrospective study of dental patient safety reports in the military health system demonstrated an increase in reported events, which may reflect improvements in safety culture. Wrong-site surgery was the most common adverse event, suggesting the need to enhance safety practices in dentistry.
Plessas A, Nasser M, Hanoch Y, et al. J Dent. 2019;82:38-44.
This randomized simulation study examined the performance of dentists on a clinical diagnostic task—interpretation of dental radiographs with and without time pressure. Dentists identified abnormal findings more frequently when they did not feel time pressure, suggesting that time pressure adversely impacted their diagnostic acumen.
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