FYI

Dentist blog from Delta Dental

Category: Q Review for California dentists (Page 1 of 2)

Q Review is an integral part of our Quality Assessment program, required by the California Department of Managed Health Care (DMHC). Articles are compiled from on-site QA review activity, as well as requirements of the DMHC, Dental Board of California and California Code of Regulations, and represent standard protocols taught in dental schools today.

Spore test your sterilizers for quality assessment

Monitoring sterilizer functionality is crucial for every office. If your California-based practice has a quality assessment (QA) review coming up, you’ll want to be absolutely certain that you’re properly spore testing all sterilizers on a weekly basis. Improperly sterilized equipment is one of the most common reasons for QA non-compliance.

Spore testing, or biological monitoring, remains the best assurance that sterilization equipment is functioning and that your office is performing instrument processing procedures correctly. Spore testing assesses the killing of highly resistant Geobacillus and Bacillus spores. Inactivation of these microorganisms strongly implies that other potential pathogens in the load have been eliminated.

Here’s a checklist of important points to keep in mind to make sure your practice is safe and compliant when it comes to spore testing sterilizers.

Spore test all sterilizers

You must test all sterilizers present in your sterilization area. If a sterilizer is not currently being used, or is considered a back-up, it still must be spore tested at least weekly. To remain in compliance, store out of use or broken sterilizers away from the sterilization space in your practice if you are not conducting weekly spore testing on them.

Spore test at least once a week

California Code of Regulations states: “Proper functioning of the sterilization cycle of all sterilization devices shall be verified at least weekly through the use of a biological indicator (such as a spore test). Test results shall be documented and maintained for 12 months.”

In addition, the Centers for Disease Control and Prevention and the American Dental Association both recommend sterilizers be monitored at least weekly with biological indicators.

Retain records of spore testing for at least a year

With mail-in services, recordkeeping is done by the monitoring service. During a QA review, the examiner reviews records related to spore testing, so be sure to have them on hand for at least the past 12 months.

Remove any sterilizer with a positive test

If a positive test is reported on a sterilizer, immediately retest the sterilizer using the same cycle that produced the positive result. The sterilizer must be removed from service until you get a passing result from the retest.  Most failed spore tests are due to operator error, so a passed retest confirms that the sterilizer is safe to use.  Remember to document both the failed test and the passing retest in this scenario.

If the retest confirms a positive spore growth, then the sterilizer must remain out of service and all instruments that were sterilized by that machine must be recalled from use and re-sterilized through a different sterilizer to confirm that they are safe for patient care. The broken sterilizer must be inspected, repaired and re-challenged by passing three consecutive spore tests taken on three fully loaded cycles prior to returning the sterilizer to service.

During a QA review, it is not uncommon for an auditor to see failed spore testing results. A failed spore test will not cause a failure of the QA review so long as the office followed and documented the proper protocols after a failed spore test to ensure safe care for patients.

Do not substitute other forms of testing for spore tests

Spore testing is the standard for assuring proper sterilization of dental instruments. Mechanical or chemical indicators can help with the detection of procedural errors or malfunctions, but they do not verify sterility, and they do not replace the need for weekly spore test.

How to refer patients to a specialist

After examining a patient, you’ve determined that an oral surgeon should take a look at a small, suspicious growth on the gum tissue. You eliminated periodontal problems, took an intraoral photograph and indicated on the patient’s treatment chart: “Referral to oral surgeon for biopsy and analysis.” Case closed? Well, not quite.

You and your staff should maintain an active role throughout the specialist referral and treatment process to help keep the patient informed and to safeguard his or her health. Each step, including those from the following list, should be included in your written office protocol document.

Specialist referral guidelines

  1. Advise the patient of your findings and the treatment risks, benefits and alternatives (including taking no action) and why you recommend a visit to a specialist. Learning that a condition is serious enough to warrant a specialist can come as a shock, so be prepared to address the patient’s questions and concerns.
  2. Schedule the appointment with the specialist while the patient is still in your office, rather than handing the patient a referral slip.
  3. Schedule a follow-up visit with your office, too, to discuss the specialist’s findings and to create a treatment plan if necessary.
  4. Contact the specialist to make sure the patient attended the appointment. If not, contact the patient to determine why he or she didn’t show up and when the appointment can be rescheduled. 
  5. Document phone discussions with the patient, the specialist and the specialist’s office staff. Keep any written correspondence in the patient’s chart.
  6. Be sure to also document any biopsy or other findings from other sources, such as a pathology laboratory used by the specialist.

You may spot health issues in your patients like high blood pressure that should be referred to a physician for management. Although these may seem to lie outside the realm of oral health, it’s best to be prepared so when you spot them, you’re ready to refer the patient appropriately. 

Taking an active role in the referral process through communication, documentation and follow-up may sometimes seem like a minor detail, but it can play a big part in maintaining patient confidence and keeping your bases covered through proper record-keeping.

5 common reasons for QA non-compliance

California practices, do you have a quality assessment (QA) review coming up? Are you just interested in making sure your practice is up to standards? Keep your eye out for these common QA violations to stay on track for great review results.

1. Instruments and handpieces not properly cleaned, sterilized or stored.

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Tip: If you have two or more sterilizers in the office, indicate on bag labels which sterilizer was used in case you receive a positive spore test result.

2. Medical emergency drug kit not on-site.

Violated guideline: All dental offices must be equipped with an emergency drug kit. Dentists must know when and how to use each drug.

Tip: Include a log in the kit that lists all emergency drugs on hand and their expiration dates. Do not include any drugs that have expired. A basic emergency kit should include:

  • injectable epinephrine
  • injectable diphenhydramine
  • nitroglycerin tablets
  • bronchodilator (albuterol)
  • chewable aspirin
  • a sugar source

3. Biological (spore) testing of sterilizers not done weekly.

Violated guideline: Each sterilizer in the office must be spore tested at least weekly.

Tip: Document in a log the spore testing process for all sterilizers, including the pass/fail results of each test. Maintain the results for at least 12 months and be sure they are on site and available for inspection during your QA review.

4. Handpieces and waterlines not flushed appropriately.

Violated guideline: Operatory unit waterlines must be flushed for two minutes in the morning before use and for 20 seconds between patients, according to the California Code of Regulations, section 1005 of Division 10 Title 16.

Tip: All staff should be able to demonstrate this task before your QA examiner.

5. Cold-sterilization log not kept.

Violated guideline: Disinfection solutions must be changed regularly, according to the manufacturer’s recommendations. When establishing change schedules also consider usage.

Tip: Keep a log of every sterilization solution change. In your log, include the brand name, date changed, name of person changing the solution and the calendar date of expiration. Make sure the log is available during your QA review.

Getting acquainted with the aspects of a QA review is an important way to improve your practice’s policies and procedures, while also preparing for future on-site assessments.

On-site quality assessment review checklist for 2021

The California Department of Managed Health Care mandates on-site quality assessment (QA) reviews for dentists in California. These reviews are helpful in comparing your own practice to the expectations of regulatory agencies and other dental professionals.

Getting acquainted with the aspects of a QA review is a great opportunity to improve your practice’s policies and procedures, while also preparing for future on-site assessments.

QA reviews focus on two aspects: structure and records. Follow the checklist below to get started on your own assessment and make note of what may need correction.

1. Structural review (about 20 minutes)

The structural review involves an assessment of the facility and equipment, as well as sterilization protocols.

Facility and equipment

  • Facility is clean and well maintained.
  • Dentist name and office hours are posted.
  • Procedure manual includes protocols for appointments, complaints, broken appointments and specialty referrals.
  • 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 with properly flushed handpieces and waterlines.

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 procedural logs are kept.
  • 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 and 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 evacuating patients in emergencies or natural disasters. The evacuation plan with clearly marked exits is displayed.
  • An active contact system can reach the dentist 24/7.
  • A portable emergency oxygen is available, 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.

2. Records review (about 1 hour and 45 minutes)

This portion involves a review of your patient care documentation.

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 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.)
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