Guidelines, standards and protocols in head and neck cancer: tools not restraints

Quality assurance and dental hygiene

Dental hygiene in Canada has experienced significant growth. It has shifted from an emerging occupation to a regulated health profession in several jurisdictions. Many achievements may be attributed to this growth, including self-regulation and a national code of ethics. However, the majority of Canadian dental hygienists are relying on traditional, outdated and ineffective quality assurance mechanisms, such as mandatory continuing education requirements. In the interests of public protection, dental hygiene needs to ensure that the quality assurance activities required from its members are effective, valid and reliable. Quality assurance in health care continues to undergo modifications that better reflect the public's need for competent, ethical, safe and appropriate health care. Dental hygienists and dental hygiene regulatory bodies are challenged to find valid, reliable and effective methods of quality assurance. This paper discusses some of the developments in quality assurance in health care as well as some of the key and significant achievements of dental hygiene in Canada. The use of quality assurance mechanisms currently used in dental hygiene in Canada is also discussed. The paper concludes with a discussion on the potential barriers and issues that the profession may face when attempting to incorporate suitable quality assurance activities into daily dental hygiene practice.

Provision and quality assurance for head and neck cancer care

In 1998, the British Association of Head and Neck Oncologists (BAHNO) published a report entitled 'Provision and quality assurance for head and neck cancer care in the United Kingdom. A nationally co-ordinated multidisciplinary approach'. This document considered, amongst other issues, operational policies for patient care. We audited three aspects of the care of 73 patients with head and neck cancer from initial referral to definitive treatment against standards set out in this report.Fifty-nine patients (81%) were seen within two weeks of initial referral, the maximum interval proposed by the BAHNO report. In 41 patients (56%), the diagnosis was confirmed and their treatment plan determined within the further two-week period suggested in the report. Of the 25 patients who required adjuvant radiotherapy, only 11 (44%) began treatment within six weeks of their surgical phase; this represented the greatest variance from the BAHNO recommendations. These findings highlight the need for units active in the treatment of specific diseases to audit their activity against available minimum standards in an attempt to improve the quality of patient care.