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In dentistry, optimal patient safety exists when all members of the dental team actively work together to ensure the well-being of each patient. When a crisis does arise, a prepared team is an effective team.
Is your practice prepared for when the unthinkable occurs and a patient experiences an adverse occurrence during or after treatment? The Dentists Insurance Company’s Risk Management Advice Line takes calls from dentists facing these challenging situations. Their guidance offers insight into effective prevention, management and assistance with reporting of adverse events.
As reported in one Advice Line call, a 38-year-old patient with special needs presented with tooth pain. The patient had been previously treated by the dentist under general anesthesia without incident. Radiographs confirmed extensive decay involving the pulp in teeth Nos. 18 and 19. The dentist discussed treatment options with the patient’s legal guardian, who agreed that the best course would be extracting the teeth under general anesthesia at a local hospital.
The hospital physician ordered that the patient temporarily suspend some of her medications on the day of treatment, including a prescribed antiseizure medication. A certified nurse anesthesiologist administered general anesthesia during the outpatient procedure. The patient went into a pseudoseizure immediately after the administration of the general anesthesia, before the treatment could begin, and needed to be admitted to the hospital that day for observation.
Two days after her admission, the patient was discharged from the hospital. A few days following discharge, the dentist’s office received a phone call from the county medical examiner’s office informing them that their patient had died. The medical examiner had questions about the medications that were administered, the vitals recorded and other procedural questions.
The dentist contacted TDIC’s Risk Management Advice Line for directions on how to handle the situation. The Risk Management analyst immediately forwarded the matter to the claims department for a referral to an attorney.
The attorney assigned to the case assisted the dentist in submitting the required regulatory report to the dental board detailing the event including the vital signs recorded, medications administered, the emergency procedures performed and their subsequent notification of the patient’s death. Even though the insured was not present or performing the treatment at the time of death, the attorney guided the dentist with the level of detail necessary for the board report. After reviewing the required regulatory report, the board concluded that no further investigation was necessary and closed the case.
At best, preventable adverse events can result in time spent providing the required regulatory notification to the state dental board. At worst, the loss of life or livelihood is irrevocable. Dedicating time and resources to implementing robust safety protocols in your practice is an essential risk management tool. Documentation and communication are key. Make certain that your office and the patient’s records have documented evidence of the following:
If one of your patients needs emergency care during treatment, your best risk management tool is a level head. Mistakes are often made when decision-making is influenced by emotions. Here are a few calm yet effective steps for responding to a crisis:
The best way to foster calm is for the whole team to be prepared. Schedule regular crisis response training and drills to ensure everyone in your practice has experience working together efficiently to manage emergencies. TDIC experts recommend crisis training at least once per year or more often if you have changes to staff.
According to TDIC’s Advice Line analysts, most state dental boards require licensees to report any adverse occurrences or events possibly related to dental treatment to their state licensing board. This includes the death of a patient following treatment. Failure to submit a report to the state licensing agency can result in discipline against a dentist’s license and potentially a finding of unprofessional conduct. Advice Line analysts suggest that if there is any question of whether an incident should be reported, it is best to file a report out of an abundance of caution.
Due to the profound consequences of failing to properly report adverse occurrences, TDIC strongly advises dentists to contact the Advice Line as soon as possible following an in-office emergency or death of a patient. (In some states, the period for reporting can be as soon as 48 hours after the event.) Knowledgeable analysts will guide you through the appropriate steps of timely board reporting and will provide the necessary referral to an attorney versed in handling board matters.
When reporting the death of a patient, state dental boards generally require the following information:
In dentistry, optimal patient safety exists when all members of the dental team actively work together to consistently apply measures and systems that ensure the well-being of each patient. When a crisis does arise, a prepared team is an effective team. Remain calm as you put into practice the emergency protocols you have established. As soon as possible following an adverse incident, contact TDIC’s Risk Management Advice Line for further guidance and resources.
TDIC’s Risk Management Advice Line is a benefit of CDA membership. Schedule a consultation with an experienced risk management analyst or call1.877.269.8844. Reprinted with permission from the California Dental Association, copyright October 2022.