Methods for Human Reliability Analysis in Dentistry

Human error (HE) is one of the main causes of accidents in different organizations and industries. Dentistry is a medical branch with a high risk of error since it involves complex manual tasks that must be performed with a high degree of accuracy. To understand the various aspects of HE in dentistry, which is crucial for developing strategies to mitigate its impact on patients' safety, it is necessary to perform a human reliability analysis (HRA). However, there is scarce data on the use of HRA in dentistry. In this paper, we give a brief description of the main phases of HRA with an emphasis on HRA methods that could be used in dentistry. Since HRA methods have been designed for diverse industrial applications, we discuss their possible application in dentistry. Among the discussed methods, the Systematic Human Error Reduction and Prediction Approach (SHERPA) and the Human Error Assessment and Reduction Technique were identified as the best candidates for performing HRA in dentistry. This is of great importance since understanding and addressing HEs is crucial for improving patient safety and the overall quality of dental care.

Increasing the margin of patient safety for periodontal and implant treatments: The role of human factors

Early complications following periodontal and dental implant surgeries are typically attributed to technique or poor biological response, ignoring the possibility of the human element. Interestingly, significant experience is not correlated with increased success, whereas evidence supports the impact of clinical behavior on patient outcome. This is the result of errors, much like those scrutinized in other high-risk technical fields, such as aviation. What can be surprising is that those who make these errors are very well acquainted with best practices. Given this, how is it possible for the conscientious practitioner to fail to apply protocols that are nonetheless very well known? Recently, the concepts of human and organizational factors have been translated to medicine, though dentistry has been slow to recognize their potential benefit. This review lists specific human factor behaviors, such as use of checklists and crew resource management, which might improve postsurgical outcome.

Preventing Wrong Tooth Extraction in Primary Care Oral Surgery: LocSSIPs - Key Aspects of Implementation for Achieving and Sustaining Compliance

The success of Local Safety Standards for Invasive Procedures (LocSSIPs) in preventing wrong tooth extraction and other patient safety incidents is based on sustained staff compliance from the outset, ahead of implementation. This paper (the second of two on the topic of LocSSIPs) aims to equip primary care dental practitioners with key practical solutions to implement LocSSIPs successfully and sustainably, and the leadership knowledge to create a long-term, safe, patient-centred and just service.

Preventing wrong tooth extraction in primary care oral surgery: developing local safety standards for invasive procedures (LocSSIPs)

Local Safety Standards for Invasive Procedures (LocSSIPs) offer a valuable way of mitigating wrong tooth extraction and other patient safety incidents during a patient's dental care journey. This paper aims to guide primary care dental practitioners in creating tailored, co-produced LocSSIPs with guidance on analysis of work systems and consideration of the patient's care journey, and provides the building blocks to create a detailed LocSSIP with a background of understanding of the importance of human factors and non-technical skills.

Patient safety in dentistry - the bigger picture

Background Patient safety incidents (PSIs) have recently become a topic of discussion within dentistry. NHS England data has highlighted that wrong tooth extraction is the most common surgical Never Event (NE); however, this data reflects mainly a secondary care picture. Consideration needs to be given to reporting of PSIs occurring in primary care.Aims To establish the current attitudes of both primary and secondary care dentists within this field and to use this to promote a positive, supportive culture.Methods A national electronic survey was sent to dentists for data capture related to this topic, from April to September 2019 inclusively.Results There were 104 responses to the survey. Responses included that 39% of responders were general dental practitioners (GDPs), 90% were aware of NEs, 48% were not aware of how to report PSIs and 74% of dentists felt that fear of the General Dental Council/Care Quality Commission repercussions was a barrier to them reporting PSIs. Additionally, 86% of dentists felt that a trainee/GDP support network would be useful to share learning regarding PSIs.Conclusion The survey results highlighted that there is a lack of knowledge concerning PSI reporting, combined with a culture of fear of the repercussions of reporting. The survey data will aim to be used to implement a supportive network for dentists, develop a positive ethos surrounding PSIs and optimise patient care.

The impact of wrong-site surgery on dental undergraduate teaching: a survey of UK dental schools

INTRODUCTION

Patient safety within dental education is paramount. Wrong-site surgery (WSS) tooth extraction is not uncommon and is a significant never event (NE) in dentistry. This study aimed to explore dental schools' undergraduate experience of NEs, safety interventions implemented and the impact on student experience.

METHODS

All 16 UK dental schools were surveyed via email.

RESULTS

The response rate was 100%. A modified World Health Organization (WHO) checklist was used within institutions (94%) including pre-operative briefings and recording teeth on whiteboards (81%, respectively). Students were directly supervised performing extractions (63%) utilising a 1:4 staff: student ratio. WSS by students was reported in 69% of schools, with student experience being impacted by an increased patient safety focus.

DISCUSSION

This study demonstrated an increased utilisation of an adapted WHO checklist. Modification of practices to ensure patient safety was demonstrated at all schools, irrespective of student WSS occurrences. Institutions experiencing student NEs commonly implemented WHO checklists and recording teeth for extraction on whiteboards. Other strategies included direct staff supervision and pre-operative briefings.

CONCLUSION

UK dental schools have increased the emphasis on patient safety by the implementation of national healthcare models, for example WHO checklists and pre-operative briefings. These strategies both aim to improve communication and teamwork. Increased levels of staff supervision foster greater quality of teaching; however, this has resulted in reduced student clinical experience. A proposed minimum standard for undergraduate surgery is suggested to ensure safe and competent dental practitioners of the future.

Dentists' perceptions of smart phone use in the clinical environment

Objective

To determine the use of smart phones in clinical practice and to determine the perceived impact on patient safety.

Study design

A closed questionnaire survey with an exploratory open question.

Setting, materials and methods

A questionnaire was sent to a sample of 216 delegates that have attended courses provided by an education provider in the North West of England between 2015–2017.

Results

There was a response rate of 49.5% which represented 107 returned questionnaires. The mean year of qualification is 2008. Of the respondents,105 were general dental practitioners, and two were hospital based dentists. Of the respondents, 82.2% had their smart phone in surgery, and of these 88% had the smart phone on silent, with the respondents on average receiving three texts, four emails and one call each session. Of the respondents, 40.9% were not aware that they received a text, 53.4% an email, and 37.5% a telephone call. Whilst 50.1% responded, in some way, to a text, 46.6% to an email and 62.5% to a telephone call. Of the respondents, 61.7% think that having a phone in the surgery is a distraction. Of the respondents, 20.7% stated that smart phones should not be allowed in the surgery under any circumstance, whilst 24.1% stated that they should be allowed if on silent and out of view, and 16.4% allowed their use but not in front of patients.

Conclusions

Eighty-eight percent of respondents had their smart phone with them in the surgery, with 61.7% reporting it to be a distraction from their clinical duties. It is our recommendation that each clinic has a protocol or policy that governs the use of smart phones focusing on patient safety.