Ensuring Patient Safety in Pediatric Dental Care

1. Need for patient safety initiatives in Korean pediatric dentistry

The presence of patient safety acts and cultural awareness varies between regions in Korea and globally and is influenced by various factors including healthcare systems, government policies, education, and institutional culture[3]. Generally, countries with advanced healthcare systems, whether developed or developing, have more advanced legal frameworks and cultural awareness regarding patient safety[4]. These countries are more likely to have various systems and programs in place to enhance patient safety. However, compared with other countries, Korea still has room for development in these aspects. In recent years, awareness of patient safety has increased in Korea, with growing interest from the government and healthcare institutions[5,6]. Nonetheless, there may still be inadequacies compared to global standards[7]. This review aims to address patient safety issues by reviewing the latest patient safety policies of the American Academy of Pediatric Dentistry (AAPD) [8], safety toolkits[9], and pediatric dental residency programs[10]. This review is expected to provide basic data for policy development and program improvements to enhance patient safety in Korean pediatric dentistry.

2. Advancement in patient safety initiatives within the Korean Academy of Pediatric Dentistry and South Korea

The Sedation Education Research Committee of the Korean Academy of Pediatric Dentistry (KAPD) was established in January 2014 and has been conducting annual sedation-related conferences and simulation training. Since 2019, it has been reorganized into the Sedation Training Institute, which offers basic education, practical training, and simulation courses targeting KAPD members. Basic (theoretical) education has been conducted online since 2020, while practical and simulation training were planned to be held twice a year. Furthermore, a reporting system for complications arising from pediatric dental sedation was developed in 2015 to evaluate adverse events. Guidelines related to pediatric dental sedation were extensively updated by the KAPD in 2017 and distributed to pediatric dentists[11]. The clinical guidelines established by the KAPD in 2016 cover various topics related to patient safety, including the administration of antibiotics, management of pediatric patients receiving chemotherapy and radiation therapy, emergency management protocols, child abuse and neglect, medical record keeping, and obtaining informed consent[12].

Patient safety concerns are being tackled not only at the academic level but also at the national level, with South Korea implementing various legislative measures and initiatives as part of its patient safety policy:

1) Healthcare Facility Accreditation System: Implemented by the Healthcare Accreditation Institute since 2011, this system ensures patient safety by requiring healthcare facilities to meet specific standards for accreditation. This enhances the establishment and operation of systems focusing on patient safety[13].

2) Patient Safety Act: Enacted in 2016, this law establishes standards and systems aimed at enhancing patient safety within healthcare institutions[5].

3) Patient Safety Reporting and Learning System: Introduced by the Ministry of Health and Welfare in 2020[14], this system within healthcare institutions reports and monitors patient safety incidents promptly, facilitating appropriate responses and providing patient safety alerts[15].

4) Comprehensive Patient Safety Plan: Following the implementation of the Patient Safety Act, the Ministry of Health and Welfare formulated the first comprehensive plan (2018-2022) to oversee patient safety[6]. This plan has led to the implementation of various policies and programs related to patient safety. The plan includes the implementation of specific policies, programs, and initiatives designed to prevent medical errors, improve communication between healthcare providers and patients, enhance reporting systems for adverse events, and promote a culture of safety within healthcare settings. The current second plan (2023–2027) is underway[16], and it is anticipated that the third plan (2028–2032) will be implemented in the future.

5) Central Patient Safety Center: The Central Patient Safety Center, established under the Patient Safety Act on July 30, 2020, is responsible for implementing measures to safeguard patients and improve healthcare quality. Additionally, South Korea designated five organizations as the first Regional Patient Safety Centers, including the Korean Medical Association, Korean Nurses Association, Korean Pharmaceutical Association, Samsung Seoul Hospital, and Kangwon National University Hospital, to collaborate with the Central Patient Safety Center on tasks aimed at enhancing patient protection, healthcare quality, and safety incident education, prevention, promotion, and support.

6) Publication of the first standardized Dental Healthcare Facility Infection Control Manual in Korea: Established by the Korean Dental Association and Ministry of Health and Welfare in 2020[17], this manual provides guidelines for infection prevention and management in dentistry.

3. Potential risks regarding patient safety issues in pediatric dentistry

1) Dental fire during dental sedation

Table 1 presents uncommon complications that may occur in pediatric dental clinics. A fire could potentially occur while a patient undergoes dental treatment. Although such incidents are rare in dentistry, they are plausible[19]. A 72-year-old woman sustained second-degree facial burns from a fire near the nasal hood, delivering a nitrous oxide-oxygen mixture, likely ignited by heat generated during the preparation of a titanium post using a high-speed, irrigated carbide bur. After evaluation for potential pulmonary complications, she was discharged from the local emergency department and later transferred to a regional burn unit, where she was discharged with second-degree burns. If the fuel source cannot be removed, the dentist should cease the open flow of oxygen or nitrous oxide-oxygen mixtures to the patient for one minute before using a potential ignition source. Additionally, intraoral suction should be employed to clear the ambient atmosphere of oxidizer-enriched exhaled gas[18,42].

Table 1.

Uncommon complications that may occur in pediatric dental clinics

Dental facilities must implement appropriate fire preparedness and safety measures to prevent burns. The risk of fire arises when the fuel, oxidizer, and ignition source converge to form a fire triangle[8] (Fig. 1). Sparks originating from burs, lasers, and electrosurgical units can also act as ignition sources[19]. Various combustible agents, such as dry gauze, throat packs, paper and cotton products, hair, petroleum-based lubricants, alcohol-based products, rubber dams, and nitrous masks, can serve as fuel[19]. The administration of oxidizers such as nitrous oxide or oxygen can generate an atmosphere enriched with oxidizers (OEA).

Fig 1.

The dental fire triangle.

Note: This triangle refers to the three essential components necessary for the occurrence of a dental fire: an ignition source, a fuel source, and an oxidizer.

4. Challenges in understanding global patient safety in pediatric dentistry

Obtaining a clear picture of patient safety in pediatric dentistry is a global challenge. Although data on incidents are crucial, they are likely to be underreported and inconsistent across countries[49]. This is due to fear of liability lawsuits, a lack of standard reporting systems, and varying definitions of what constitutes an error. Despite these challenges, adverse event studies have provided glimpses into potential problems. Dental patient adverse event research is primarily conducted through three main methods. The first involves deriving insights from case reports, which, although limited, provide detailed information on each case, aiding in a substantive understanding of adverse events (AEs)[49]. Obadan et al.[49] investigated the safety of dental patients by reviewing reported AEs. Researchers have found that misdiagnosis leading to delayed or unnecessary treatment was the most common issue. Although deaths have been reported in some cases, permanent harm was more frequent. These findings highlight the need for a better understanding of dental AEs and their causes.

The second method entails researching AEs experienced by dental practitioners through surveys[50]. However, issues, such as respondent participation rates and sample selection bias, may arise. Nicola et al.[51] surveyed pediatric dentists in the United States regarding adverse events during dental care for children. Between October and December 2019, an anonymous online survey was conducted with 11 percent of AAPD members. Of the respondents, 91% reported experiencing at least one AE in a child during dental treatment. The two most prevalent AEs, each reported by 82% of respondents, were self-inflicted trauma to soft tissues after local anesthesia and nausea and vomiting. The annualized estimates for these events were 7,816 and 7,003, respectively. Major AEs (respiratory depression, cardiovascular depression, neurological damage, death) during pediatric dental treatment were reported by 14% of respondents (annualized estimate=443). “Wrong” errors (wrong tooth/wrong procedure/wrong patient) were reported by 24% of respondents (annualized estimate=600).

Finally, trigger tool-based adverse event detection in electronic health records (EHRs) provides another avenue for studying dental adverse events[52-54]. The trigger tool was initially designed as a manual method for healthcare professionals to review patient records[55,56]. Kalenderian et al.[57] explored the use of EHRs to improve the detection of AEs in dentistry. However, there has been growing interest in semi- or fully automated adverse event detection methods utilizing EHRs, which require less time and personnel resources for identifying AEs[58]. Currently, most dental institutions rely on manual chart reviews to identify AEs, which is inefficient[59]. Implementing prospective AE-detection through automated surveillance systems using EHR data can provide real-time feedback to healthcare professionals, enabling timely intervention[60]. Although not perfect, trigger tool-based automated adverse event detection showed promise as a more efficient way to detect AEs compared to manual methods.

5. Defensive dentistry

Hellyer and Radford[61] have observed a growing trend in “defensive dentistry” over the past decade. Their study reported that experienced dentists may increasingly choose to perform only low-risk or risk-free procedures. Dentists are shifting their practices due to concerns about patient safety, often prioritizing risk reduction to prevent complications. The fear of facing legal action is a driving force behind treatment decisions as dentists navigate complex medico-legal considerations[62,63]. Additionally, concerns regarding the health and safety of both staff and patients are prompting adjustments in practical approaches, particularly to minimize the risks of exposure to infections or injuries. This could have negative potential consequences on the overall oral health of the population, as experienced dentists may limit their scope of practice[64].

1. Developing a culture of safety

The concept of safety culture originated from studies conducted outside healthcare, focusing on high reliability organizations (HROs) that consistently minimize adverse events despite engaging in complex and hazardous work[65]. These organizations prioritize safety across all levels, from frontline providers to upper management. Research has shown significant differences in perceptions of safety culture across various organizations and job roles[66]. Surveys are commonly used to measure safety culture, with validated options including the Agency for Healthcare Research and Quality’s (AHRQ) Surveys on Patient Safety Culture^™ (SOPS^®)[67] and the Safety Attitudes Questionnaire (SAQ)[68]. The AAPD’s patient safety policy prioritizes fostering a culture wherein staff members feel empowered to address patient safety concerns[8]. This includes encouraging team members to voice their concerns and take the necessary actions to ensure patient safety.

2. Infection control

The AAPD issued a comprehensive policy statement addressing infection control measures in dental settings. First, they endorsed the CDC guidelines for infection control[69,70], sterilization, and management of hepatitis B infection, recognizing them as vital resources for maintaining safety in dental practices. Second, the AAPD urges dental practitioners to stay updated with current literature and meticulously implement infection control measures to minimize the risk of disease transmission. This includes heat sterilization of all dental handpieces between uses, including low-speed motors and reusable prophylaxis angles. Furthermore, the AAPD emphasizes the importance of proactive infection control practices among dental providers and their teams. Additional training may be beneficial for staff members to effectively address parental concerns regarding infection control practices within treatment facilities. This policy also highlights the necessity of developing a water management plan for dental unit waterlines to ensure that routine maintenance procedures are followed to maintain low bacterial counts. Additionally, practitioners are advised to use irrigants for operative and surgical procedures in line with the CDC recommendations. Conventional dental units may not reliably deliver sterile water; therefore, single-use disposable syringes should be used to dispense irrigants during pulpal therapy and oral surgical procedures. Finally, the AAPD stresses the need for clinicians to take necessary precautions to prevent potential backflow associated with the use of saliva ejectors, further safeguarding patient safety in dental settings.

3. Medical error reduction

This topic discusses an approach that directs attention to systemic weaknesses that facilitate errors rather than attributing faults to isolated incidents. The systems approach to error analysis in healthcare, pioneered by Reason[71], emphasizes that errors often result from flaws in the overall system rather than from individual failings. This approach views errors as inevitable and seeks to identify the underlying system flaws to prevent or minimize their impact on patients. Errors are classified into active errors, typically made by frontline personnel, and latent errors, which stem from organizational or design failures. Techniques such as root cause and failure mode effect analyses are used to analyze errors and develop solutions with a focus on redesigning protocols, devices, and work environments to reduce the risk of slips and mistakes[72]. Creating a culture of safety in which reporting errors is encouraged and frontline workers are not punished for slips is crucial for improving patient safety. Preventing pediatric medication errors through the use of such systems is a prime example of avoiding individual mistakes[73].

4. Waterline safety

Many healthcare facilities and dental practices adhere to recommended guidelines for regularly monitoring and maintaining the quality of DUWL to enhance patient safety. There are several checklists and recommendations in the United States for complying with DUWL standards, primarily based on the guidelines published by the ADA[74], OSAP[75], and CDC[76]. These checklists and recommendations include the following:

1) Regular monitoring of water quality in DUWL systems.

2) Flushing and disinfection protocols for DUWL systems.

3) Use of appropriate treatment products and maintenance of DUWL systems.

4) Training for dental personnel on DUWL maintenance and infection control.

5) Compliance with manufacturer recommendations for DUWL equipment and products.

These guidelines aim to ensure the safety and quality of water used in dental procedures, thereby reducing the risk of infection for both patients and staff.

5. Sedation and general anesthesia safety

Recent research has examined the safety of deep sedation in outpatient pediatric dentistry (2017-2019 records) [77]. Although convenient, outpatient deep sedation may have unpredictable risks; 8.6% of children experienced issues (AEs) such as dizziness, breathing problems, or allergic reactions. The AAPD suggests the “Use of anesthesia providers in the administration of office-based deep sedation/general anesthesia to the pediatric dental patient” as a best practice recommendation. This best practice is intended to assist dental practitioners who choose to employ a currently licensed anesthesia provider to deliver deep sedation/general anesthesia to pediatric dental patients in a dental office or non-hospital, non-ambulatory surgical center setting. This best practice emphasizes the need for thorough documentation and procedures for ensuring safe and high-quality care for pediatric dental patients undergoing deep sedation or general anesthesia. The key components include documenting the reasons for sedation, obtaining informed consent, providing clear instructions to patients and parents, conducting preoperative health evaluations, maintaining detailed anesthesia records, and recording recovery notes. It also underscores the importance of implementing risk management and quality assurance measures. Additionally, utilizing in-office anesthesia providers can offer safe and compassionate care alternatives, particularly when access to traditional surgical facilities is limited.

6. Nitrous oxide safety

Nitrous oxide, which is extensively used in pediatric dental clinics, plays a vital role in assisting certain patients. However, the inadvertent inhalation of excessive nitrous oxide by staff can lead to adverse health outcomes. First, it is crucial to carefully evaluate the patient selection criteria (e.g., tolerance of the nasal hood, ability to breathe through the nose, cooperative potential, recent illnesses, indications, and contraindications) before administering nitrous oxide. Several studies have suggested that the use of nitrous oxide in patients with intraocular gas tamponade following vitreoretinal surgery may induce blindness[32-34].

Additionally, scavenging waste anesthesia gases is crucial[78]. Scavenging refers to the process of suctioning and eliminating the waste nitrous oxide exhaled by a patient during a procedure performed under nitrous sedation. Waste anesthesia gases consist of small quantities of volatile anesthetic gases that escape from the patient’ s anesthesia breathing circuit into the air in operating rooms during anesthesia delivery[78]. Double-chamber mask delivery systems outperform single-chamber masks with scavenging caps in removing excess nitrous oxide gas[79,80]. Employing a properly fitted doublechamber mask along with the recommended scavenging system flow rate can effectively reduce occupational exposure to nitrous oxide gas.

7. Medical emergencies in the dental office

Non-dental medical emergencies may occur when families visit pediatric dental facilities. It is necessary to document observable symptoms, signs, and management strategies[81], for potential emergencies that may occur in dental clinics. Additionally, documentation of the indications and dosages of medications available for use in emergencies is required. Preparing protocols in advance and ensuring that all staff members undergo training are crucial steps to promptly address emergencies that may arise in dental practice.

8. Comprehensive informed consent

The provision of a patient consent form is mandatory. Beyond simply preparing a patient consent form, it is essential to consider how to provide information to patients effectively and empower them to make informed choices. This safety toolkit section offers various training tools for professional societies, universities, and companies to facilitate this process. The AAPD provides recommendations for informed consent in their best practice section[82]. Consent forms should be tailored to the procedure, use straightforward language, and avoid broad statements. When practitioners use an informed consent form, the following items should be included: 1. Legal name and date of birth of patient; 2. Legal name and relationship with the pediatric patient/legal basis on which the person is granting permission on behalf of the patient; 3. Patient’s diagnosis; 4. Nature and purpose of the proposed treatment in simple terms; 5. Potential benefits and risks associated with the treatment in simple terms; 6. Professionally recognized or evidence-based alternative treatment – including no treatment – to recommended therapy and the risk(s) of each treatment modality in simple terms; 7. Place for the parents to indicate that all questions have been asked and adequately answered; and 8. Places for the signatures of parents, dentists, and office staff members as witnesses.

9. Dental records and record keeping

Documentation and patient records are essential components of a successful dental practice[83]. They contain crucial details regarding the patient’s treatment plan and the care they received. Dental records play a significant role when submitting dental benefit claims or responding to legal matters, such as lawsuits. Although these records serve as a form of insurance, it is important to only include information relevant to dental care. Adhering strictly to your established record-keeping format is vital, as anything documented can potentially be presented in a court of law. Information that should not be noted in dental records includes[84]:

1) Financial information: This includes ledger cards, insurance benefit breakdowns, insurance claims, and payment vouchers. Financial records are separate from clinical records and should be maintained independently.

2) Personal opinions or criticisms: It is important to refrain from documenting the subjective opinions or criticisms of patients. While it is acceptable to document instances such as a patient’s refusal of recommended treatment or information about canceled appointments, any disparaging comments or informal notes should be avoided, as they may need to be disclosed in the event of a lawsuit.

3) Patients’ personal information: Personal information should be kept separate from medical and dental records. Creating a separate form for collecting personal information will facilitate the maintenance of separate files. Team members can use this form to record each patient’s special interests, hobbies, and activities.

10. Office design safety

Office design safety encompasses a range of topics in pediatric dental practices, from safety-promoting office design to toy safety. These factors represent the physical attributes of the interiors of dental clinics that either facilitate or impede the provision of a safe environment. It is important to prepare a toy safety checklist, especially for toddlers and young children because they may be particularly vulnerable to risks[85,86]. Choking is the fourth leading cause of unintentional death, the primary cause of infantile mortality, and the fourth leading cause of death among preschool children[87]. The most frequently implicated objects in choking incidents are food items, coins, balloons, and toys. According to a review by the CDC on nonfatal choking incidents among children treated in emergency departments, 13% of cases were linked to coins, while 19% were attributed to candy or gum ingestion. Among the aspirated foreign bodies resulting in fatalities, latex balloons were the most common, accounting for 29% of deaths due to foreign body aspiration between 1972 and 1992. During the same period, hot dogs emerged as the most lethal food item causing aspiration, accounting for 17% of food-related aspiration fatalities. Following are some tips to ensure toy safety[85]:

1) Check the Label: Most toys on the market are safe, but it is still crucial to check the labels for age recommendations. Toys designed for children aged 3 - 6 years may pose choking hazards to younger children.

2) Consider Age and Development: The age recommendation for a toy considers physical and mental abilities and safety aspects. Toys should always be chosen appropriately for a child’s age and developmental stage.

3) Prevent Choking: Avoid small toys and parts for children under 3 years of age, as they may mouth objects and risk choking. Toys should be regularly checked for loose parts to ensure that they are sturdy. Beware of items including latex balloons[88-90], bean bag chairs, and small batteries or magnets[91].

4) Avoid Falling: Keep riding toys away from stairs and bodies of water. Supervise children on riding toys and ensure proper fit.

5) Prevent Suffocation and Strangulation: Discard plastic wrapping immediately and keep strings away from cribs and playpens[92]. Be cautious of strings, ropes, or cords that could strangle a child. Watch out for loose or long clothing parts and remove hood cords from playground equipment.

6) Prevent Other Injuries: Be wary of toys that shoot projectiles or make loud noises, as they can cause eye and hearing injuries. Electric plug-in toys and hobby kits may cause burns or shocks if misused. Chemistry sets and similar kits should be used with caution because of the presence of toxic substances and fire hazards. Toy chests can pose risks of pinching, bruising, or suffocation.

11. Personnel security

Occupational violence is universally deemed unacceptable in professional settings. Within the healthcare sector, including dentistry, safeguarding workers’ well-being is paramount. Healthcare workers face various forms of violence, ranging from physical assault to nonphysical acts such as shouting, bullying, threats, and even sexual harassment[93]. Violence can significantly impact workers, leading to decreased quality of work, psychological issues, and, in rare cases, resignation from their positions. The increasing incidence of occupational violence against oral healthcare professionals underscores the urgent need for improved protective measures to establish safe working environments for dental practitioners.

Incidents of violence within medical institutions continue to occur in South Korea. The Korean Dental Association strives to protect dental healthcare professionals by distributing a “Violence and Threat Response Manual” [94] and a “Dental Healthcare Provider Violence Prevention Poster”[95]. Ongoing worksite analyses and hazard identification are crucial for the effectiveness of a comprehensive workplace violence prevention program[96]. Risk factors for workplace violence in healthcare settings encompass various aspects, including those related to patients, clients, and settings, as well as organizational factors[97].

12. IT security

Cyberattacks have been persistently occurring in the international dental community recently[98,99]. IT security in the dental field involves safeguarding digital systems, networks, and data against unauthorized access, use, or modification. Not only industrial sectors, but also organizations possessing personal patient information, have fallen victim to such cyber threats. The US Department of Health and Human Services Office for Civil Rights is currently providing a list of hacking incidents under investigation[100]. With the escalating sophistication of cyberterrorism, the importance of protecting personal information has become increasingly important. The use of programs utilizing patient imaging or treatment data has rapidly increased among medical professionals in the AI era[101-106]. With various diagnostic and treatment programs utilizing patient data, ensuring the safe and effective use of systems in the medical field requires addressing security and privacy threats related to AI.[107,108]. The Cyber Essentials Toolkit consists of modules aimed at simplifying the Cybersecurity and Infrastructure Security Agency (CISA) Cyber Essentials into manageable actions[109]. This enables C-suite leadership in the healthcare sector to progressively prepare for each Cyber Essential.

1. What are HROs?

The excerpt from “Human Error” delineates two primary perspectives on error management[71]. The Person Approach holds individuals accountable for errors, citing factors such as forgetfulness, inattention, and inadequate skills as the causative elements. In contrast, the Systems Approach attributes errors to systemic issues, such as ineffective communication, insufficient training, or ambiguous procedures. This advocates for designing systems that mitigate the risk of human error and facilitate safer task performance.

HROs are examples of the systems approach in action. HROs, such as nuclear power plants and air traffic control systems, operate in complex environments with high risks, but maintain exceptional safety records. Their success is attributed to a culture that prioritizes safety and acknowledges human variability as a fact of life, even using it as a safeguard. HROs achieve this by anticipating problems, promoting communication, and adapting to challenges. By focusing on the system as a whole, rather than blaming individuals, HROs create a safer environment for everyone involved. The distinction between the individual and systems approaches is an important concept not only in human factors engineering but also in patient safety within the healthcare field.

2. What is the safety culture?

Table 2 presents the key points and benefits of the three safety cultures[71]. Just culture centers on promoting sincere reporting of safety concerns within an organization. Its key aspects include incentivizing and acknowledging individuals for reporting safety issues and distinguishing between inadvertent mistakes and intentional negligence. This approach yields benefits such as fostering an environment where staff can openly report errors without apprehension of reprisal, thereby facilitating the early detection and resolution of potential issues. Reporting culture emphasizes the establishment of an environment wherein individuals feel at ease reporting errors and near-misses. The key to this is reporting incidents, regardless of how minor a regular and anticipated practice is. These benefits include gathering valuable data for learning from past incidents and fostering a collective sense of responsibility toward safety. A learning culture prioritizes the active utilization of safety reports to enhance organizational practices. Key components include the organization’s readiness to analyze safety data and enact significant changes if needed to enhance safety. This approach offers benefits, such as fostering ongoing enhancements in safety performance and showcasing a dedication to patient safety and risk mitigation. These three safety cultures complement each other to establish a robust safety environment. To summarize, a just culture encourages reporting, a reporting culture captures data, and a learning culture uses data to drive improvement, ultimately enhancing overall safety performance and risk-reduction efforts.

Table 2.

Key points and benefits of the three safety cultures

3. Why is leadership important for fostering a safety culture?

Leaders must enforce policies and communicate them clearly to all team members[112]. The Joint Commission document outlines an 11-step approach to creating a strong safety culture within an organization[113]:

1) Encourage Open Reporting: Be transparent and nonpunitive when staff report mistakes, close calls, and unsafe conditions. This allows for learning and improvement.

2) Distinguish Blame from Errors: Develop fair systems to separate human error from poorly designed systems and intentionally unsafe acts.

3) Leaders Set the Tone: Leaders must champion safety and eliminate bullying behaviors to build trust within the organization.

4) Communicate Safety Policies: Clearly communicate policies that support a culture of safety and encourage incidents reporting.

5) Recognize Safety Efforts: Acknowledge and reward staff who report issues, identify risks, or suggest safety improvements.

6) Measure Safety Culture: Utilize surveys such as the Agency for the AHRQ Hospital Survey on Patient Safety Culture (HSOPS) or alternative tools such as the Safety Attitudes Questionnaire (SAQ) to establish a starting point and monitor advancements in fostering a secure environment.

7) Analyze Data, Identify Opportunities: Analyze safety data to identify areas for quality improvement and patient safety.

8) Implement Safety Initiatives: Develop and implement targeted actions to improve the safety culture within each unit.

9) Integrate Safety Training: Embed safety training into quality improvement projects and everyday processes.

10) Proactively Assess Systems: Identify and address weaknesses in systems such as medication management and EHRs.

11) Continuously Monitor Progress: Regularly assess the organization’s safety culture to track progress (every 18 - 24 months) and ensure long-term improvement.

4. What is the SBAR tool?

Effective communication between healthcare providers and patients is crucial for patient safety and shared decision-making[114]. The Situation-Background-Assessment-Recommendation (SBAR) technique offers a structured approach to communication among healthcare team members regarding a patient’s condition[115]:

S = Situation (a concise statement of the problem)

B = Background (pertinent and brief information related to the situation)

A = Assessment (analysis and consideration of options — what you found/think)

R = Recommendation (action requested/recommended — what you want)

The SBAR serves as a practical tool for framing critical conversations and facilitating immediate attention and action from clinicians. It aids in setting communication expectations among team members and promoting teamwork and a patient safety culture. Practicing communication strategies with dental teams and patients, fostering safe environments, and ensuring effective communication between providers and patients is crucial for patient safety and shared decision-making[116].

5. What is a mortality and morbidity session?

Mortality and morbidity (M&M) sessions are regular meetings held in healthcare settings, typically in hospitals or medical institutions, where healthcare professionals gather to review and discuss cases involving patient deaths or adverse events (morbidity)[117]. These sessions serve as a forum for clinicians to reflect on clinical outcomes, identify factors contributing to adverse events, and explore opportunities for improvement in patient care practices, procedures, and systems[118]. The primary goal of M&M sessions is to promote continuous learning, quality improvement, and patient safety within the healthcare organization[119]. Dental hospitals, similar to medical institutions[120], also need to integrate M&M sessions into dental resident education[121].