Good Communication Improves Patient Care

Donald Wood, CRNA, CPHRM, Patient Safety/Risk Manager, The Doctors Company

Multiple studies have shown that communication challenges can cause health care errors and complications. Dentists regularly provide care to patients who require a health care team with several medical specialties. In these circumstances, dental care provided to a patient requires effective communication among all team members and the patient.

Case Study
A patient presented to a dentist for a scheduled procedure. As the patient was being prepared for the procedure, the patient inquired about the use of an antibiotic. The patient explained that he had undergone joint replacement surgery, and his orthopedic surgeon had instructed the patient that an antibiotic should be provided prior to any dental work. The dentist explained to the patient that current guidelines don’t support the concept of administering antibiotics prior to a dental procedure and was reluctant to prescribe an antibiotic. The patient wanted to discuss the dentist’s explanation with his orthopedic surgeon. He cancelled the procedure and left without being treated.

When a patient’s medical history reveals a prior surgery, the need for collaboration between the dentist and any previous treating physician may warrant a discussion. In this case, an orthopedic surgeon performed the joint replacement. The 2013 clinical practice guideline published jointly by the American Association of Orthopaedic Surgeons and the American Dental Association (ADA), further clarified by the 2014 guideline from the ADA Council on Scientific Affairs, does not specify the need for antibiotic prophylaxis for patients with a prior joint replacement surgery. However, many variables should be considered. The guidelines report that a patient with a medical history of osteomyelitis, acquired immunodeficiency, or drugs or disease that suppress the immune system may require antibiotic prophylaxis before dental procedures.

Effective collaboration, in this situation, includes notifying the orthopedic physician about the need for the dental procedure, the extensiveness of the procedure and inquiring about the need for pre-operative antibiotics based on the patient’s orthopedic history. This collaborative process should begin as soon as a need for a dental procedure is determined.

A similar situation may arise with patients on antithrombotic therapy. This therapy requires a collaborative approach with the physician prescribing the medication. Although the number of antithrombotic medications was relatively limited in the past, several new medications have been approved. These new medications are noteworthy in that for some, there is no testing for therapeutic effect and some have no antidote or reversal agent. To reduce the risk of excessive bleeding, it may be necessary for a patient who is undergoing antithrombotic therapy to temporarily cease taking the medication for several days. As a part of the communication process, the dentist and prescribing physician should determine when the patient can safely resume taking their medication. Documentation in the dental record should indicate the patient’s understanding of when to stop the antithrombotic medication and when to resume taking it. With effective communication among the dentist, treating physician and patient, the overall impact on the patient’s health can be minimized.

Risk Management Strategies
Clear, concise communication can be enhanced by implementing the Situation-Background-Assessment-Recommendation technique. This technique can help a dentist organize communication and present specific details while collaborating with a patient’s previous physician. The following is an example:

  • Situation: A 58-year-old patient with pain, cold sensitivity and advanced periodontal disease.
  • Background: History of total knee replacements in 2010 and 2015.
  • Assessment: Patient needs to have four teeth extracted, bone grafting and preparation for implants.
  • Recommendation: Assess the need and timing of any antibiotic therapy that may be necessary prior to this procedure. If indicated, provide the patient with a prescription for the antibiotic.

Track these requests in a log or other format to determine if a response was received prior to the procedure. Follow up to ensure that communication among the dentist, prior specialists and patient is successful.

 

References:
Jevsevar D, Abt E. The new AAOS-ADA clinical practice guideline on prevention of orthopaedic implant infection in patients undergoing dental procedures, J Am Acad Orthop Surg 2013; 21: 195-197. http://www.aaos.org/Research/guidelines/PUDP/dentaleditorial.pdf.

Sollecity T, Abt E, Lockhart P, et al. The use of prophylactic antibiotics prior to dental procedures in patients with prosthetic joints. J Am Dent Assoc. 2015; 146(1); 11-16 e8. http://jada.ada.org/article/S0002-8177(14)00019-1/fulltext#sec3.

SBAR technique for communication: A situational briefing model. Institute for Health care Improvement website. http://www.ihi.org/resources/Pages/Tools/SBARTechniqueforCommunicationASituationalBriefingModel.aspx. Accessed February 16, 2017.

 

Reprinted with permission. ©2017 The Doctors Company. For more patient safety articles and practice tips, visit www.thedoctors.com/patientsafety.

Pictures are Worth a Thousand Words

In this video, Dr. Mark Kleive shares the value of taking a hands-on photography course for every dental practice.

 

Dr. Mark Kleive will be speaking at FDC2017 and presenting three courses. On Thursday, June 22, his course, “The Fun Way to Proficiency with Digital Photography (Workshop)” will be at 9 a.m., and “A Picture is Worth Two Words: Case Acceptance” will be at 2 p.m. On Friday, June 23, “Successful Hiring, Team Development and Retention” will be at 9:30 a.m. To register, please go to www.floridadentalconvention.com.

An Early Bite with Dr. John Paul: “Doc, Just Give Me a Reline”

By Dr. John Paul, FDA Editor

If you are a dentist, and you practice in Florida, you are more than likely to have a patient walk into your office and ask to have their dentures relined. Many are convinced that this is a simple procedure handled entirely by a technician, and the dentist is just a toll collector on their highway to better eating and speaking. “I’m paying you good money, just put the stuff in my teeth so I can be happy.”

I focus on the “make me happy” part. I want you to have comfortable, functional dentures that allow you to speak and eat with confidence. You know they “don’t fit.” I want to know why you aren’t comfortable. That requires an examination and evaluation. I will definitely want to look at your mouth and touch the parts that support your dentures. I may want to take an X-ray to determine the quality of your bones.

More often than you might guess, the patient’s dentures fit their jaws fine, but do not stay in under function. The teeth don’t mesh together properly and that is why they seem “loose.” No need for a reline, just adjust the bite. There are times when the bones have changed shape and the denture no longer fits. That’s when we take an X-ray to determine if the bones are healthy but a different shape, or if the reason for the change is disease in the bones, like cancer. We need the X-ray to make that diagnosis, and the treatment plan may be something much different than “just a reline.”

Without a proper examination, evaluation and treatment plan, it isn’t possible to provide appropriate treatment. What makes for a proper examination and evaluation is specific to each patient and is something you should discuss with your dentist. I can’t make my diagnosis based solely on information provided over the internet, and you shouldn’t rely only on what you read on the internet to make your decision.

Have a question you have a tough time answering? Send it to Dr. Paul at jpaul@bot.floridadental.org.

Why Plastic Deserves Your Time and Attention

By Dr. Lisa Knowles, Intentional Dental Consulting

It’s hard to fathom what 500 years from now will look like, but I do know one thing that will be around if our planet still exists: plastic. Plastic takes about 500 years to biodegrade — if ever. Scientists estimate this number of years based on extrapolated figures using a respiratory test. They take a sample of plastic and see how long it takes microorganisms to digest the plastic. The amount of CO2 respired is the measured indicator of degradation. Except with plastic, no CO2 is made. Instead, plastic is dependent upon photodegradation. And no one is certain how long it will take the sun to complete this process. So, 500 years is the current guestimate.

I could not help myself from thinking about the amount of plastic consumed in our daily lives. After thinking about this sobering 500-year fact, I started to think beyond my traditional reduce, reuse, recycle mode of environmental consciousness. I thought I was doing a decent job of preserving the planet and educating my children about consuming less, but once I began to think with the end in mind — as Steven Covey recommends in “The Seven Habits of Highly Effective People” — I realized the end for plastic may never come. With that realization, I began my plastic witch hunt at home and in my work places. (Please note that there are pros and cons to paper and plastic usage, and this article focuses on plastic).

Here are 10 ways to taper the plastic temptations:

  1. If you have to use plastic, ensure that you are buying a piece of plastic that was made from recycled plastic. There is no need to make more new plastic than we already have on this earth if we do not need it. There is a type of toothbrush called Preserve that is made from 40 percent recycled yogurt containers. It’s a start. When you do buy plastic, recycle it after using it. Every piece of plastic thrown in the trash ends up buried in a landfill, and it will not see the light of the sun. There is no chance it will photodegrade. That plastic toy, fork, bubble wrap or fast food container will likely be there for eternity.
  2. Ask for less packaging, and think ahead and eliminate plastic bags and wraps. Take reusable cargo bags or backpacks to drug stores, grocery stores, shopping malls and markets.
  3. Ignore the undereducated or put off checkout worker who looks at you with grief when you ask for paper bags (or no bags) while gathering up your purchases. And, choose retailers that gladly offer environmentally conscious check out options.
  4. Consider less disposables in your office. We chose sterilization pouches from Enviropouch instead of thousands of little plastic bags for each instrument cassette. When I price compared how much it takes to buy the bags and all of the wrapping and taping products, the Enviropouch purchases evened out. When I add in the long-term cost savings to the environment, the Enviropouch killed the competition.
  5. Think about purchases on small things like polishing disks. I could have purchased a kit with plastic polishing disks and rubber attachments that came packaged in a plastic holder, but I chose the paper sand disks that come in a small rectangular cardboard box. Sure, it’s not as fancy looking, and it’s not the latest and greatest packaging and marketing color-pleaser. But, it pleases the environment, and it was much, much less expensive.
  6. Insist on a recycling program within your office. The amount of stock we all receive in our offices is extensive. When stock, cardboard boxes go into the landfill, it takes up unnecessary space, and landfills get used up faster. Landfills are inevitable, but we can reduce the rapid filling of them by recycling every thing that is possible. Shredded office paper and regular copy paper can be recycled (shred the confidential materials).
  7. Print on both sides of the paper and use fonts that use less ink. Comic Sans is a font that uses much more ink than some others. Patrick Allan, author of a Life Hacks article recommends Calibri, Times New Roman or Century Gothic; be careful with Century Gothic, however, because its wide font uses more paper. Use draft mode or fast mode to use less ink when it’s not crucial to have the best quality. The less ink we use, the more money we save, and fewer ink cartridges go into a landfill. Do not forget to recycle the ink cartridges. Most office supply stores take those back and recycle them.
  8. Save all the paper and ink costs and waste by emailing documents and using shared file folders within the office. Although paper biodegrades faster, the pollution factor for paper and plastic manufacturing is quite high. Paper mills often use bleach to whiten paper and this releases dioxins into our waterways and grounds around paper mills.
  9. Find local recycle events to recycle unusual things like batteries, bicycles and eyeglasses. My local event (Ingham County, Mich.) is called Recycle Rama. Also, unwanted medicine often is taken at these events, and great for us to remind and recommend to our patients when they ask us what to do with their unused prescriptions.
  10. Be an advocate for environmental consciousness. The healthier we keep our environment, the healthier we keep our bodies and minds. Clutter clogs our minds and physically impedes our outdoor recreation. Pollution from manufacturing plastic and paper produces potentially harmful diseases and illnesses in our bodies and increases our overall health care costs.

When we begin with the end in mind, and actively help to promote a total health and wellness environment for our patients, the choices we make as business owners and health care professionals can impact the environment and our way of life for years to come — maybe even 500 years to come. Small changes in our daily lives not only save us on business costs, but also helps to preserve the future health of our planet and of our patients. As health care professionals, shouldn’t we be leading the way?

 

Resources:
https://www.sciencelearn.org.nz/resources/1543-measuring-biodegradability
http://lifehacker.com/three-fonts-you-should-use-instead-of-arial-to-save-pri-1764110335

Dr. Knowles has a consulting business, Intentional Dental Consulting, and can be reached at IntentionalDental@gmail.com.