Preventing Dental Never Events with the use of Surgery Safety Checklists

Wrong tooth extraction is an all-too-common occurrence in the dentistry field, as the error makes up nearly 20-25% of wrong site surgery events and 6-9% of all preventable adverse incidents. The implications for patients can be both time consuming and costly, and the repercussions for dental hospitals providers are equally damaging. Although little research has been done to examine workable methods to reduce the incidents of wrong tooth extractions throughout the UK, a recent survey points to promise among a handful of dental hospitals in preventing the avoidable event altogether.

In June 2016, a self-assessment survey was presented to 16 clinical directors of major dental hospitals through England and Ireland, specifically asking about their practices as it relates to dental surgeries, like tooth extraction. Although three did not provide any response, all 13 of the respondents shared that the use of a common error prevention tool was used with all patients undergoing a significant procedure in a surgical setting. The safer surgical checklist, first introduced to the UK healthcare landscape in 2009, is one of the methods the 13 responding dental hospitals say is a necessary component of preventing adverse incidents like wrong tooth extractions.

Behind the Checklist

The safer surgical checklist provides a guideline for preventative measures that healthcare providers can take to avoid missteps in the operating room. It was implemented as a safety strategy in 2009 in correlation with a publication of never events – incidents in which preventable harm took place during a surgical procedure. Currently, all NHS organisations utilize the checklist for major surgeries performed throughout the country as part of an initiative to make medical care more streamlined and beneficial to patients across various practices, all in an effort to reduce the occurrence of never events.

Although the majority of NHS trusts were quick to adopt the use of checklists as a method to prevent never events from taking place in hospital theatres, dental hospitals that performed operations like tooth extraction were not necessarily included in the mandatory use guidelines. The reasoning behind this revolved around the issue of tooth extractions not clearly falling into the category of surgery as defined within the never events directive. Until 2015, the list of never events did not specifically include wrong tooth extractions as a preventable problem and therefore, did not clearly state reporting of the adverse incident was required by dental surgeons who encountered the common issue.

According to a representative from a leading medical solicitor firm in the UK, wrong tooth extractions are now a part of the never events list identified by NHS and patient advocacy groups. The updated definition of a preventable event includes surgical intervention that is performed at the wrong site, including a tooth. Wrong tooth extractions, then, meet the standards of a never event, making them reportable but more importantly, avoidable in the course of a patient’s medical care plan.

Creating Safer Care in Dental Hospitals

Very few studies have been conducted on the use of safer surgery checklists, specifically in dental hospitals, to avoid costly missteps that have the potential to affect patients adversely. However, the recent survey from major dental hospitals throughout England and Ireland highlights the fact that checklists are being used not only for major procedures like tooth extractions but for some less severe out-patient procedures as well. The use of safer surgery checklists is an important step toward providing the highest level of care possible to patients, but the initiative is not known to work well as a standalone strategy.

A significant number of errors in the operating room take place because of a lack of communication between the patient, the hospital staff, and the provider. In some instances, information regarding which tooth needs to be extracted is not clear when relayed to the surgeon, creating fertile ground for a wrong site surgery that becomes a burden to both the patient and the hospital. In addition to poor communication tactics, competency, and procedural compliance is lacking. Somewhat more pressing, however, is the lack of organisational culture that promotes patient safety as a top priority among all parties involved. Without a strong combination of meaningful communication methods, advanced training for staff and providers, and an overarching narrative encouraging the highest quality care, safer surgical checklists are simply a placebo for reducing never events throughout the healthcare system.