It is an inevitable fact of life that things don't always go according to plan, so it's important to know how to deal with these situations when they arise. Being prepared for the unexpected can help prevent matters from deteriorating and avoid you being criticised for your handling of the issue.
The same principles for analysing what happened can be applied to all situations, ranging from the small issues which create minor inconvenience to a significant untoward event. The following three questions are the ones to think about.
- What happened?
- Why did it happen?
- What can be done to help prevent a similar situation happening again?
Understanding what happened is usually fairly straight forward. But when looking at the reason, try to dig into the background. For example, if a patient was given the wrong appointment time, was this a system error, such as the computer system not working correctly, or was it a human error? If it was a human error, was it due to a lack of concentration or a lack of training? By spending a bit of time analysing this, the best solutions to help prevent a similar error happening can be applied.
Once the analysis has taken place you can then decide if it should be shared, and if so, who with. Very minor issues might not need to be formally recorded and shared with anyone, but good communication in the workplace, including sharing issues, can sometimes be helpful in preventing a larger error from occurring.
Any analysis needs to be carried out in a no-blame way, but this is often easier said than done, especially if there is the potential for someone to have been harmed. However, it is easier to analyse the more significant events if everyone is open and honest.
For example, if a dental nurse narrowly avoids a sharps injury, it can be easy for the nurse and dentist to become defensive and blame each other. A better approach is to look carefully at each step of the process that led up to the near miss and decide what the team can change to help prevent someone getting a sharps injury in the future.
It can be tempting to try and be helpful by saying what investigations should be carried out - but don't overstep your expertise.
If a patient is injured during treatment, it's essential to make sure they receive any immediate care they might need. It might be appropriate for this to be provided by you, but don't be afraid to refer if it is outside your scope as a dental professional.
For example, if there is the potential for an object to have been inhaled, refer the patient to a medical colleague so they can be investigated and treated as appropriate. Providing as much information as possible about the object that has gone missing, and the circumstances that led to this, will be important.
This should include giving details of the size of the object and what is it made from, which will allow the person who assesses the patient to choose the most appropriate investigations to conduct. Looking for a small piece of acrylic that has broken off a dental appliance will need to be approached differently to looking for an endodontic file.
It can be tempting to try and be as helpful as possible by saying what investigations should be carried out, such as asking for a chest X-ray - but don't inadvertently overstep your expertise.
Think about who might be best to refer the patient to. Much will depend on the urgency of the situation. If the medical care is not urgent, like treatment of a patch of dermatitis after a mild allergic reaction, it might be appropriate to refer the patient to their GP.
But if the situation requires immediate attention, such as a hypochlorite incident, make the necessary arrangements for the patient to receive immediate hospital care after you have administered any first aid required.
After the event
Ensure the patient receives any ongoing care they might need, which might include their dental care as well as any medical care.
For example, if a patient has suffered nerve damage after an implant placement, they're likely to need care to deal with the nerve damage and care to enable restoration of their dentition. It might be appropriate for you to provide all, some or none of this, but make sure you consider all aspects of ongoing care - not just care for the injury.
As ever, it's important to keep good records of any incident. Note what happened, what advice was given and, if necessary, what follow-up should happen. If an incident needs to be reported, do so in the timeframes required. You can find out more on this by reading our related guide on the statutory duty of candour.
Although it can be daunting at first, taking an open and honest approach to any adverse incident or near miss is usually a much more comfortable way to proceed.
It allows you the chance to not only deal with the incident in a calm and professional way, but also to fully analyse what has happened so you can try and make sure that no-one else follows in your footsteps.
Remember we're here to help too, and the earlier you contact us for support, the sooner we can advise you on the best course of action. If you're a member, you can contact us here.
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Deputy head of the DDU
Deputy head of the DDU
Leo Briggs qualified from University College Hospital, London, in 1989. He has worked extensively in the community dental service including a brief period overseas. He has also worked in general dental practice.
Leo gained a masters degree in periodontology from the Eastman in 1995 and is on the GDC specialist register for periodontics. From 1995-2017 he provided specialist periodontal treatment in both the salaried dental services and private practice. He started working for the DDU in 2005. Between 2007 and 2009 he worked part time at the DDU and part time as a clinical tutor at the School for Professionals Complementary to Dentistry in Portsmouth. In 2009 Leo went full time with the DDU. In January 2016 he became deputy head of the DDU.
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