Import data set to SPSS and analyse results

Running head: Patient Safety and Risk Management in Dental Practice: Are There Enough

Guidelines? An Evaluative Study on The Existing System in a Dental College of Riyadh 1

Patient Safety and Risk Management in Dental Practice: Are There Enough Guidelines? An

Evaluative Study on The Existing System in a Dental College of Riyadh

Introduction

While it is essential to the practice of healthcare professionals to concern about patient

safety, it is relatively current that it has been transformed into a specific body of knowledge and

therefore patient safety may be considered as a relatively ‘innovative’ discipline. Its core ideas

are to prevent the occurrence of avoidable adverse events (errors, complications and accidents)

accompanying the practice of healthcare and to reduce the impact of unavoidable adverse events.

This is a simple definition for the multifaceted, complexed nature and many key elements in the

practice of patient safety. There are economic, financial, social, cultural and organizational

matters of a patient safety environment that makes it unpractical to simply define it as the

practicing safe health care or protecting patients from harm by health care professionals. It is

essential for all health care professionals and health care organizations to become more

acquainted with the overall framework of patient safety, to dynamically contribute in hard work

to apply patient safety procedures in everyday practice and to create a culture of patient safety

culture (Yamalik & Perea Pérez, 2012).

There is a constant concern and interest in dentistry for matters related to patients and

practicing safe and quality care in the everyday dental practice. Yet, like other health

professions, more attention is given to patient related matters and safety-related matters

(Yamalik & Dijk, 2013).

Furthermore, there is an emerging professional consideration of risk management, patient

safety and handling errors. Rather than hiding them, errors are now understood as learning

material and by that, the number of publications on dental errors are increasing. As an example,

Patient Safety and Risk Management in Dental Practice: Are There Enough Guidelines? An

Evaluative Study on The Existing System in a Dental College of Riyadh 2

prescribing errors in dental practice is a potential ground for development in the medication

management process and patient safety (Yamalik & Dijk, 2013).

An empirical data on the attitudes of dental professionals and dental auxiliaries about the

reporting of medical errors was collected in Riyadh, Saudi Arabia by Al-Nomay et al., (2017),

most respondents (94.4% of them) expressed that medical errors should be reported. Yet, insights

of the norm, personal preferences and existing practices regarding which type of error should be

reported were inconsistent. Only 17.9% of respondents perceived that reporting errors that results

in major harm is the present practice. More than 68% of the participants disclosed a personal

belief, a perception of the norm and a present practice that errors must be reported by the erring

dentist. Respondents at government establishments were more likely to report errors than those at

private establishments (Al-Nomay et al., 2017).

The Problem

Dentists are now practicing more surgical procedures in their dental setting, the

possibility of experiencing litigation from malpractice has significantly increased. Having good

skills and techniques are not sufficient enough; dental professionals must dynamically and

thoroughly adhere to strategies of reducing risk to support the minimizing or eliminating harm

and lawsuits. The dentist can avoid possible harm and lawsuits by devoting better attention to

detail, by adhering to good practice, and managing patients’ expectations and outcomes in an

improved matter (Dym, 2012).

Dental professionals are at risk of being exposed to severe implications on health from

occupational exposure to infections. It has been previously acknowledged in several areas and

researches the matters of compliance with risk management procedures, the effects of which can

be reduced by technical developments, employment of guidelines in best practice and by

Patient Safety and Risk Management in Dental Practice: Are There Enough Guidelines? An

Evaluative Study on The Existing System in a Dental College of Riyadh 3

regularly emphasizing policies of infection control locally with training and awareness

campaigns (Westall & Dickinson, 2017).

A study done by Alhamad et al., (2015) in the Eastern Province of Kingdom of Saudi

Arabia reporting the prevalence of medical emergencies in dental clinics and self‑perceived

competence of dentists. Over 60% of the participants have encountered medical emergencies at

least once. The most common medical emergency experienced by the dentists is vasovagal

syncope by 53.1%, hypoglycemia 44.8% and foreign body aspiration was reported by only 5.5%.

Over 74.3% of the respondents stated that they are supplied with emergency kits in their clinics.

Around 33% of the dentists in the study were either lacking confidence or lack the knowledge to

use emergency drugs (Alhamad et al., 2015).

Reducing the risk for medication error by improving dental prescriptions quality and to

encourage the rational use of prescriptions, and patient safety. One study reported that dental

extractions are shown to be related with a low but substantial postoperative risk of sepsis,

particularly in senior patients and those with chronic systemic diseases. In an investigation

regarding errors of radiographs with undergraduate students, it was observed that 64.06% of the

images were acceptable, and 35.94% of the images were unacceptable. Accordingly, it was

proposed that good training and knowledge of the distribution of anatomical region and the types

of error can help prevent these errors and retaking of the radiographic images. Reporting and

examining errors could significantly benefit in identifying the core contributing factors (Yamalik

& Dijk, 2013).

Purpose of the Study

According to the mentioned literature, knowing and analyzing the factors that cause

errors is critical in order to initiate changes which will prevent the errors. It also critical to

Patient Safety and Risk Management in Dental Practice: Are There Enough Guidelines? An

Evaluative Study on The Existing System in a Dental College of Riyadh 4

understand that single errors or events are usually the outcome of the convergence of several

contributing factors. For that, preventing errors necessitates a systemic approach to change the

conditions that lead to these errors (Yamalik & Dijk, 2013).

Like all healthcare professionals, it is also expected from dental professionals to have an

improved knowledge, awareness and concern when it comes to patient safety and risk

management, and that it is practiced in the daily dental care delivery. Though, patient safety is

more widely recognized in healthcare organizations all over the world, numerous health

professionals still do not effectively practice it. Moreover, healthcare students are not widely

taught regarding the practice of patient safety and risk management (Yamalik & Dijk, 2013).

Significance of The Study

The aims of this study are:

1. To improve awareness of the significant risk of errors during the delivery of dental care

among dental professionals.

2. To provide data on the working practices and clinical environment of dental clinics and how

they prevent errors from happening in the first place,

3. To focus on the problems with compliance to risk management procedures in dental clinics,

4. To recognize and recommend possible methods and practices to prevent occupational errors,

5. To recommend future studies to investigate the compliance with risk management system

between dental professionals by studying their perspective.

Research Question

To analyze the perspectives of dental professionals on the current practices of risk

management and patient safety guidelines in order to prevent dental practice errors from

Patient Safety and Risk Management in Dental Practice: Are There Enough Guidelines? An

Evaluative Study on The Existing System in a Dental College of Riyadh 5

happening. Evaluate the current guidelines applied in dental facilities and assess its efficacy and

effectiveness in patient safety and risk management.

Methodology

The included population number in the government dental college in Riyadh, Saudi

Arabia from faculty, clinicians, interns and fourth and fifth year students are a total of 152. A

self‑administered questionnaire to110 randomly selected from the included population to achieve

a confidence rate of 95% and a margin error of 5%. The questionnaire is prepared and modified

under the supervision of an experienced faculty member.

The questionnaire has been pilot tested on a sample of 15 licensed dental professionals

practicing in government and private clinics in Riyadh to test participants’ understanding of the

questions and prevent errors in its administration. The pilot study was tested for validity using

Cronbach’s alpha validity test with a .9376 reliability score. The study objectives will be

described prior to the questionnaire for the respondents to comprehend and give an informed

consent. Licensed dental physicians, dental hygienist and dental students in the fourth year and

above are included in this study. Dental students who have less than a year of dental care

experience and dental assistants will be excluded from this study.

The questionnaire will consist of six sections, first section will cover questions on

demographics: The number of years in dental practice, dental qualification and the field of

experience in dental practice (private, government or both), and the academic qualifications of

the dental professional. The second sections will cover questions on the participants general

knowledge in risk management and patient safety (Yamalik & Dijk, 2013). Section three will list

errors associated with clinical documents, information and referral of patients in the dental clinic,

questions will ask if there are risk management and patient safety guidelines to prevent those

Patient Safety and Risk Management in Dental Practice: Are There Enough Guidelines? An

Evaluative Study on The Existing System in a Dental College of Riyadh 6

errors from happening. Section four will list pharmacological prescribing errors, questions will

ask if there are risk management and patient safety guidelines to prevent those errors from

happening and the source of the guidelines. Section five will list errors from surgical events,

questions will ask if there are risk management and patient safety guidelines to prevent those

errors from happening and the source of the guidelines. Section six will list probable accidents

(random events, unpredicted and unanticipated injury or harm to the patient) in dental practice,

questions will ask if there are risk management and patient safety guidelines to prevent those

errors from happening and the source of the guidelines (Yamalik & Perea Pérez, 2012).

Statistical Software Package SPSS will be used to perform statistical analyses. Frequencies and

proportions of diverse responses will be measured for categorical variables.

Results

Appropriate statistical methods and tests will be used for analysis of the results.

Discussion

The results obtained will be discussed considering the available local and international

studies and review.

Conclusion and Recommendations

The conclusion and recommendations will be derived from the results and discussion.

Patient Safety and Risk Management in Dental Practice: Are There Enough Guidelines? An

Evaluative Study on The Existing System in a Dental College of Riyadh 7

References

AlBaker, A. A., Al-Ruthia, Y. S. H., AlShehri, M., & Alshuwairikh, S. (2017). The

characteristics and distribution of dentist workforce in Saudi Arabia: A descriptive cross-

sectional study. Saudi Pharmaceutical Journal, 25(8), 1208-1216.

Alhamad, M., Alnahwi, T., Alshayeb, H., Alzayer, A., Aldawood, O., Almarzouq, A., & Nazir,

M. A. (2015). Medical emergencies encountered in dental clinics: A study from the

Eastern Province of Saudi Arabia. Journal of family & community medicine, 22(3), 175.

Al-Nomay, N. S., Ashi, A., Al-Hargan, A., Alshalhoub, A., & Masuadi, E. (2017). Attitudes of

dental professional staff and auxiliaries in Riyadh, Saudi Arabia, toward disclosure of

medical errors. The Saudi dental journal, 29(2), 59-65.

Dym, H. (2012). Risk management in the dental office. Dental Clinics, 56(1), 113-120.

Westall, J. O., & Dickinson, C. (2017). Compliance with occupational exposure risk

management procedures in a dental school setting. British dental journal, 222(11), 859.

Yamalik, N., & Dijk, W. (2013). Analysis of the attitudes and needs/demands of dental

practitioners in the field of patient safety and risk management. International dental

journal, 63(6), 291-297.

Yamalik, N., & Perea Pérez, B. (2012). Patient safety and dentistry: what do we need to know?

Fundamentals of patient safety, the safety culture and implementation of patient safety

measures in dental practice. International dental journal, 62(4), 189-196.