Audit in Dental Practice
Warren Tolley BDS, MPhil
Dental Practice Advisor Powys
Why Bother with audit?
• To help identify potential problems before it is
too late!
Clinical Audit
• Encourages individual GDPs and PCDs to self
examine different aspects of their practice
• Identify areas of improvement
• Ensure that quality is being maintained
The Audit Cycle
Set Standards
Observe current
practice
Implement
change
Compare
Against
standards
How do I enter the cycle?
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Decide on a topic that you wish to audit
Decide on the standards to be achieved
Collect data on current practice
Compare this data to your standards
Make changes where necessary
Repeat at intervals to complete the cycle
Key Points
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S.
M.
A.
R.
T.
Specific
Measurable
Achievable
Realistic
Time (Can be completed on time)
Who to involve?
• Dentists and PCDs within one dental practice
• Collaborative- A joint audit between 2 or more
dental practices
• Avoid single audits
• Collaborative audits are excellent for single
handed practices especially in rural areas
Remember
• Introducing clinical governance to primary
care, the government stated that it "must be
seen as a systematic approach to quality
assurance and improvement within a health
organisation . . . Above all clinical governance
is about changing organisational culture
. . . away from a culture of blame to one of
learning so that quality infuses all aspects of
the organisation's work.
The Good News
• Funding is available for approved projects
• A maximum of 15 hours for completed
projects is funded at £65.07 per hour
• A maximum of £130 travel allowance per
project
• The convenor of the project can additionally
claim an extra 2.5 hours and secretarial
support
Possible Topics
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Clinical
Dentures
Crown and bridge
Deciduous restorations
periodontology
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Administrative
Record keeping
Health and safety
Cross infection
Timekeeping
An Audit of Cross Infection
Control and Practice
2007
Objectives
• To establish that a series of cross infection control procedures
were being carried out in line with the individual practice
cross infection control policy
• To audit both the dentist and nurse in cross infection
• To review each individuals cross infection control policy and
compare it with the BDA A12 document and implement any
changes as required
• To carry out a second audit
• To make any further amendments following the second cycle
Method
• A data collection sheet was devised to look at a series of 12
cross infection control procedures that are commonly carried
out in dental practice
• The dentist and nurse filled in the data sheet
• Prior to the audit each practice was asked to review their
cross infection control policy in order to accurately fill in the
form
• 10 patients were observed for each category
Cross Infection Control Procedures
1.
2.
3.
4.
5.
6.
7.
8.
9.
Instrument decontamination and sterilisation
Medical history form checked and updated
Impressions disinfected and disinfectant used
Clinical waste disposal and storage
Protective clothing used
Items intended for single use disposed of
Water lines disinfected
Safe sharp disposal
Correct storage of sterile instruments
10. Aspirator cleaned and disinfected
11. Surfaces disinfected and disinfectant used
12. Zoning between clean and dirty areas
practiced correctly
Score Codes
• 1= Practice best practice
• 2= Minor Fault
• 3= Serious breach of cross infection control
policy
Data Analysis
• Data was collected from each practice
• Kruskal-Wallis statistical test was used ( this
test is appropriate for non-parametric data)
First Round Audit Results
• Statistical differences for categories 1 and 5
• No scores of 3 were produced
• Categories 7,8,and 12 had increased scores of
2
Conclusions of audit 1
• Category 1: Nurses wearing latex gloves to
clean instruments
• Category 5: Dentists wearing prescription
glasses
• Category 7: Confusion on Disinfection of DWLs
• Category 8: needle re-sheathing device
• Category 12: Touching key board/door handles
with dirty gloves
Second round data collection
• A12 document was read and discussed
• Amendments were done to individual practice
cross infection control policies
• All practice staff were briefed on any changes
• The audit was repeated
Second round data
• Statistical difference (P<0.05) in category 5
• The frequency of score 2 was reduced
• No scores of 3 were awarded
Frequency of score 2 in first round
Frequency of score 2 in second
round
Conclusions
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No serious breaches occurred
Dentists are reluctant to wear protective glasses
Useful in allowing nurses to observe dentists
Both phases demonstrated a high standard
Discussion phase of the audit is useful especially in a rural
setting
• The audit would be repeated on a regular basis and from
part of new staff induction training
• All staff would be encouraged to attend postgraduate
courses
Audit Project References
• The BDA A12 document
• Dental update
• Public Health Wales
Where do I get information
• www.dentpostgradwales.ac.uk
• www.cardiff.ac.uk/pgmde/dental
mick@mickhorton.co.uk
Finally.............
• “It is not the strongest species that survive,
nor the most intelligent that survives. It is the
one that is most adaptable to change”
• “To kill an error is as good a service as, and
sometimes even better than the establishing
of a new truth or fact”
Charles Darwin