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Category: Q Review for California dentists

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On-site quality assessment review checklist for 2019

On-site quality assessment (QA) reviews are part of our quality assessment program for dentists in California, mandated by the California Department of Managed Health Care.

A QA review gives you a look at how the many components of your practice compare to the expectations of dental professionals, regulatory agencies, dental educators and Delta Dental.

QA reviews are conducted in two parts:

  1. Structural (about 20 minutes): Review of your facility and equipment, as well as emergency, sterilization and infection control protocols.
  2. Records (about 1 hour and 45 minutes): Review of patient treatment documentation for relevance and acceptability under current standards of patient care.

The following list highlights just some of the aspects of a QA review. It can serve as a useful tool to help you review your practice through the eyes of the QA examiner. Together with your staff, you can evaluate your office policies and procedures and be even better prepared for a future on-site QA review.

Structural review

Facility and equipment

  • Facility is clean and well maintained, dentist name and office hours are posted.
  • Procedure manual includes written protocols for new and recall appointments, documenting complaints, broken appointments, specialty referral.
  • Accessibility/reasonable accommodations exist for patients with disabilities, such as wheelchair access and a grab bar in the restroom.
  • Waterlines have anti-retraction valves installed and maintained, handpieces and waterlines are properly flushed.

Radiology

  • Certificates are current and equipment inspection dates are posted.
  • Lead (or lead-equivalent) apron with thyroid collar is used.

Sterilization and infection control

  • Staff is trained in infection control standards and logs are kept of procedures followed.
  • Gloves, masks, protective attire and eyewear are used appropriately.
  • Weekly biologic monitoring is conducted and records are kept.
  • Instruments and handpieces are properly sterilized, stored and labeled.

Safety and emergency procedures/equipment

  • Drugs, syringes and needles are properly stored; a log is kept of drugs dispensed on site.
  • Required certifications are up-to-date.
  • A modern evacuation system exists for nitrous oxide.
  • Written office protocol includes staff responsibilities for assisting/evacuating patients in emergencies or natural disasters, evacuation plan is posted and exits marked.
  • An active contact system can reach the dentist 24/7.
  • Portable emergency oxygen is available, tank is full and there is a positive pressure valve and/or Ambu bag; staff are trained in use.
  • Mercury hygiene and safety requirements are observed.
  • Medical emergency kit is up-to-date.

Records review

Medical and dental history

  • Medical history forms include yes/no questions, identify patient’s existing conditions and contain comprehensive health information.
  • Dental history includes baseline information, TMJ/occlusion status, appliances, periodontal condition and results of soft tissue/oral cancer exam.

Treatment notes

  • Progress/treatment notes are legible and in ink
  • Included, as appropriate, are:
    • Referrals to specialists
    • Records forwarded or received
    • Anesthetic used (type, amount and concentration of any vasoconstrictor)
    • Medications prescribed
    • Laboratory instructions

Quality of care

  • Professionally acceptable standards of care are observed for:
    • X-rays — adequate number, appropriate frequency, of diagnostic value, mounted and labeled
    • Treatment plan — in ink, consistent with diagnosis and exam findings, alternative and elective treatment documented with the patient’s choice and reason
    • Treatment sequence — in order of need
    • Informed consent — documentation that treatment plan was reviewed and patient understands risks, benefits, alternatives and costs; any refusal of recommended care is documented

Outcomes of care

  • Patient records demonstrate effectiveness of preventive care
  • Overall comprehensive documentation demonstrates that treatment was provided as appropriate, including:
    • Good prognosis for appropriate longevity
    • Evidence of need (x-rays, pocket charting etc.)
    • Minimal unplanned treatment or retreatment
    • Referral to a specialist in a timely manner
    • Post-operative instruction given
    • Follow-up (pocket charting, x-rays etc.)

On-site Quality Assessment review checklist

On-site Quality Assessment (QA) reviews are part of our Quality Assessment program for dentists in California, mandated by the California Department of Managed Health Care.

A QA review gives you a look at how the many components of your practice compare to the expectations of dental professionals, regulatory agencies, dental educators and Delta Dental.

QA reviews are conducted in two parts:

  1. Structural (about 20 minutes): Review of your facility and equipment, as well as emergency, sterilization and infection control protocols.
  2. Records (about 1 hour and 45 minutes): Review of patient treatment documentation for relevance and acceptability under current standards of patient care.

The following list highlights just some of the aspects of a QA review, and is a useful tool to help you review your practice through the eyes of the QA examiner. Together with your staff, you can evaluate your office policies and procedures and be even better prepared for a future on-site QA review.

Structural review

Facility and equipment

  • Facility is clean and well-maintained, dentist name and office hours are posted
  • Procedure manual includes written protocols for new and recall appointments, documenting complaints, broken appointments, specialty referral
  • Accessibility/reasonable accommodations exist for patients with disabilities, such as wheelchair access and a grab bar in the restroom
  • Waterlines have anti-retraction valves installed and maintained, handpieces and waterlines are properly flushed

Radiology

  • Certificates are current and equipment inspection dates are posted
  • Lead or lead-equivalent apron with thyroid collar is used

Sterilization and infection control

  • Staff is trained in infection control standards and logs are kept of procedures followed
  • Gloves, masks, protective attire and eyewear are used appropriately
  • Weekly biologic monitoring is conducted and records are kept
  • Instruments and handpieces are properly sterilized, stored and labeled

Safety and emergency procedures/equipment

  • Drugs, syringes and needles are properly stored; a log is kept of drugs dispensed on site
  • Required certifications are up-to-date
  • A modern evacuation system exists for nitrous oxide
  • Written office protocol includes staff responsibilities for assisting/evacuating patients in emergencies or natural disasters, evacuation plan is posted and exits marked
  • An active contact system can reach the dentist 24/7
  • Portable emergency oxygen is available, tank is full and there is a positive pressure valve and/or Ambu bag; staff are trained in use
  • Mercury hygiene and safety requirements are observed
  • Medical emergency kit is up-to-date

Records review

Medical and dental history

  • Medical history forms include yes/no questions, identify patient’s existing conditions and contain comprehensive health information
  • Dental history includes baseline information, TMJ/occlusion status, appliances, periodontal condition and results of soft tissue/oral cancer exam

Treatment notes

  • Progress/treatment notes are legible and in ink
  • Included, as appropriate, are:
    • Referrals to specialists
    • Records forwarded or received
    • Anesthetic used (type, amount and concentration of any vasoconstrictor)
    • Medications prescribed
    • Laboratory instructions

Quality of care

  • Professionally acceptable standards of care are observed for:
    • X-rays - adequate number, appropriate frequency, of diagnostic value, mounted and labeled
    • Treatment plan - in ink, consistent with diagnosis and exam findings, alternative and elective treatment documented with the patient’s choice and reason
    • Treatment sequence - in order of need
    • Informed consent - documentation that treatment plan was reviewed and patient understands risks, benefits, alternatives and costs; documentation of any refusal of recommended care

Outcomes of care

  • Patient records demonstrate effectiveness of preventive care
  • Overall comprehensive documentation demonstrates that treatment was provided as appropriate, including:
    • Good prognosis for appropriate longevity
    • Evidence of need (x-rays, pocket charting, etc.)
    • Minimal unplanned treatment/retreatment
    • Referral to a specialist in a timely manner
    • Post-operative instruction given
    • Follow-up (pocket charting, x-rays, etc.)

Test sterilizers weekly

For California dentists: Q Review -- Winter 2017

Testing all your office sterilizers each week is required by the California Dental Board.* This requirement includes using biologic indicators and testing all sterilizers, even those used infrequently or as backup.

Proper functioning of the sterilization cycle is verified by using biologic (spore) indicators. Biologic indicators consist of highly resistant bacterial spores of Geobacillus stearothermophilus for steam and chemical vapor sterilizers, or Bacillus atrophaeus for dry heat sterilizers.

Other types of indicators, such as paper strips or packaging that changes color under heat and pressure, are not substitutes for biologic indicators.

In addition, every sterilization cycle that contains implantable devices should be monitored with a biologic indicator and the implantable devices quarantined until the biologic indicator test results are known.

During an onsite Quality Assessment review, the examiner checks your in-office spore testing log to ensure your compliance with regulations. Be sure to:

  • Keep sterilizer test results for the previous 12-months and have them available during the review.
  • Note in your log the weeks that the office is not open to treat patients (since weekly testing is required).
  • Remove sterilizers from your office that are not tested weekly.

 

* California Code of Regulations 16 CCR § 1005[b] [17] Minimum Standards for Infection Control.

You can help minimize drug abuse

Dentists often prescribe hydrocodone or oxycodone combination analgesics for short-term, acute pain management. For example, every year, millions of adolescents receive their first introduction to opioid analgesics following third molar extractions.

Although most opioid prescriptions do not result in abuse or addiction, opioid misuse is on the rise. As prescribers of 12%1 of immediate-release opioids in the U.S., dentists can help combat this national epidemic. Here are some steps you can take:

  • Prescribe the minimum quantity needed to manage pain.
  • Incorporate substance abuse education into your practice.
  • Intervene if a patient exhibits signs or symptoms of drug abuse. Refer the patient to a local program and/or interact with the patient’s physician.

In addition, if you are authorized to prescribe schedule II - IV drugs, you must have registered for access to the prescription monitoring program – CURES 2.0 – by July 1, 2016 or when a DEA Controlled Substance Registration Certificate was issued, whichever occurred later. The registration requirement is based on possession of a DEA certificate and dental license, not on drug dispensing, prescribing or administering activities.

For more information, visit the California prescription drug monitoring program at the California Department of Justice CURES 2.0 website.

 

1 According to the July 2011 JADA article, “Prevention of prescription opioid abuse.

“Caleb’s Law” takes effect in California

Q Review -- Summer 2017

In response to the tragic deaths of two otherwise healthy children who received dental treatment while under anesthesia in 2015 and 2016, California Governor Jerry Brown signed Assembly Bill 2235 into effect on January 1, 2017.

AB 2235, referred to as “Caleb’s Law”, amends the Dental Practice Act to require the Dental Board to:

  • Generate a report on whether current regulations for pediatric dental anesthesia provide adequate protection to the pediatric dental patient
  • Require dentists to report a pediatric death or transportation to a hospital related to general anesthesia
  • Require that written informed consent forms contain certain language

AB 224, the follow-up pediatric sedation bill, has been tabled for this year. It is a two-year bill, and since it was not defeated, it could return next year for consideration.

AD 224 redefines “general anesthesia” and defines “deep sedation.” AB 224 also includes these requirements for any dental procedure involving general anesthesia or deep sedation:

  • For patients under 7 years of age, there must be present the operating dentist, a dental sedation assistant and a dedicated monitor, all of whom possess the appropriate Dental Board permits and life support and airway management training.
  • For children between 7 and 13 years of age, the operating dentist must have present at least two support staff of which at least one must possess the appropriate life support and airway management training.

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