Policy on Patient Safety

Policy statement

The AAPD encourages oral health care professionals to prioritize patient safety in the delivery of care and to consider the elements of their practice that may be improved to minimize the occurrence of critical errors and complications. The AAPD urges oral health care professionals to adhere to federal and state laws, guidance, and programs that protect patients and their families. Active engagement with current best practices, technology, and public health concerns is crucial to providing safe, patient-centered care.

To promote patient safety, the AAPD also supports:

• patient safety instruction in dental curricula and continuing education.
• compliance with infection control policies, procedures, and practices in dental health care settings to prevent disease transmission from patient to care provider, from care provider to patient, and from patient to patient.
• routine inspection of physical facility with regards to patient safety. This includes development and periodic review of office emergency and fire safety protocols and routine inspection and maintenance of clinical equipment.
• recognition that effective communication practices, including informed consent by the parent and assent from the child when applicable, can help avoid problems and adverse events.
• accuracy of patient identification by using 2 or more patient identifiers (eg, name, date of birth) when providing healthcare treatment or services.
• an accurate and complete patient chart, including consistent use of standardized abbreviations, acronyms, and symbols that can be interpreted by a knowledgeable third party.
• an accurate, comprehensive, and up-to-date medical/dental history including medications and allergy list to ensure patient safety during each visit. Ongoing communication with health care providers, both medical and dental, who manage the child’s health helps ensure comprehensive, coordinated care of each patient.
• a pause or time out with dental team members present before an invasive procedure to confirm the patient, planned procedure, and tooth/surgical site are correct.
• inclusion of fire prevention and management protocols in procedure and emergency plans, including a time out that assesses fire risk.
• appropriate staffing and supervision of patients treated in the dental office.
• adherence to AAPD recommendations on behavior guidance, especially as they pertain to use of advanced behavior guidance techniques (ie, protective stabilization, sedation, general anesthesia).
• standardization and consistency of processes within the practice. A policies and procedures manual, with on-going review and revision, may increase employee awareness and decrease the likelihood of untoward events.
• minimizing exposure to nitrous oxide by maintaining the lowest practical levels in the dental environment. This includes routine inspection and maintenance of nitrous oxide delivery equipment as well as adherence to clinical recommendations for patient selection and delivery of inhalation agents.
• minimizing radiation exposure through adherence to the as low as reasonably achievable (ALARA) principle, equipment inspection and maintenance, and patient selection criteria.
• all facilities performing sedation for diagnostic and therapeutic procedures to maintain records that track adverse events. Such events then can be examined for assessment of risk reduction and improvement in patient safety.
• dentists who utilize in-office anesthesia providers take all necessary measures to minimize risk to patients. Prior to delivery of sedation/general anesthesia, documentation shall address rationale for sedation/general anesthesia, informed consent, instructions to parent, dietary precautions, preoperative health evaluation, and any prescriptions along with the instructions given for their use. Rescue equipment should have regular safety and function testing, and medications should not be expired. The dentist and anesthesia providers must communicate during treatment to share concerns about the airway or other details of patient safety.
• clear, procedure-specific posttreatment instructions to patients/parents to minimize risk of injury or complications when being discharged from the oral health care professional’s supervision.
• ongoing quality improvement strategies and routine assessment of risk, adverse events, and near misses. A plan for improvement in patient safety and satisfaction is imperative for such strategies.
• comprehensive review and documentation of indication for medication order/administration. This includes a review of current medications, allergies, drug interactions, and correct calculation of dosage.
• vigilance in monitoring public health concerns (eg, surges in respiratory infection cases ). This includes taking steps to ensure patient and staff safety as recommended by local and national sources with recognized expertise.
• promoting a culture where staff members are empowered and encouraged to speak up or intervene in matters of patient safety.
• staff and provider training on burnout recognition and prevention, self-care, and access to confidential mental health counseling and substance abuse programs.