Unit 5. Quality Assurance and Quality Improvement
Quality Assurance & Quality Improvement

Section 3. Measuring to Improve Quality

Clinical Quality Control

A number of excellent protocols have been developed to monitor equipment function. The following describe detailed QC processes that are important to any dental clinic.

Bonding agents and light-cured composite materials are a standard part of restorative dentistry. The proper function of the bonding agents and composite materials depends on the adequacy of their cure, which in turn depends on the wavelength and intensity of the curing-light unit in use. While the wavelength of the curing light is set by the manufacturer, the intensity of the light can be affected by many conditions present in the dental clinic and frequently diminishes over time. Several companies make radiometers to measure the intensity of the lights, and your lights should be tested at least weekly and the results kept in a log. Whenever the light intensity falls below 400 to 500 milliwatts per square centimeter, the light should be serviced.

Every clinic should have an emergency kit that includes the drugs and instruments needed to treat medical emergencies that may occur in the clinic. Some states specifically define what needs to be in the kit, so it is important to check your state dental law. Since all drugs have a finite shelf life, a log of the items in the emergency kit and their expiration dates should be kept and checked on a regular, fixed schedule. Items should be replaced when they reach their expiration dates.

As part of your preparedness for potential medical emergencies, your clinic should have a source of emergency oxygen that can be used in each operatory as well as in other parts of the building. Emergency oxygen should be considered part of your emergency kit. The status of the oxygen supply should be checked and recorded on a regular basis, probably no less than weekly. Accreditation agencies may require daily monitoring. If your oxygen unit provides positive-pressure oxygen for patient ventilation, then the proper function of the positive-pressure device should also be tested and recorded.

All oral surgery, endodontic, and periodontal surgery procedures will be followed up with a phone call to the patient at the end of the day. If problems are noted, the dentist will take appropriate measures to resolve the situation.

To enact this policy, the following procedures should be in effect:

  • Each dentist will keep a daily log of all oral surgery, endodontic, and periodontal surgery procedures.
  • The dentist will have his or her assistants call each patient and ask if there are any problems with pain or swelling and record findings in the post-treatment log.
  • All conversations with patients or concerning the patient, including phone calls, should be noted in the patient treatment record. All attempts to contact the patient, even if unsuccessful, should be noted in the treatment notes.
  • The assistant will notify the dentist if the patient indicates that he or she is having problems. The dentist will take appropriate measures to address the patient’s concerns.
  • At the end of the week the lead dentist will collect the daily procedure tracking logs for the dentists and file them in a permanent folder.
  • The log should be kept, in addition to all other logs.

Almost all dental equipment comes with a preventive-maintenance schedule recommended by the manufacturer. One of the best ways to ensure that downtime in the clinic due to equipment failure is minimized is to follow those schedules. You should maintain a log or checklist of all of the dental equipment in your clinic and the maintenance schedules for each piece, and then check off and date the log whenever maintenance takes place. You may choose to contract with a dental supply company such as Patterson to provide maintenance services, and if you do, they can probably maintain the preventive maintenance schedule for you.

Even though most dental practices utilize digital radiology now, there are still some that do not. For those practices it is important to note that the diagnostic quality of the X-rays depends on having both the X-ray machine and the film processor functioning within appropriate parameters. Most states have regulations governing the licensing and calibration of the X-ray machine itself. The proper function of the processor, on the other hand, is up to the dental clinic.

Dental Radiographic Devices, P.O. Box 9294, Silver Spring, MD 20906, (301) 598-6543, sells a device called the dental radiographic normalizing and monitoring device for testing the processor to ensure that it is consistently developing dental X-rays. This should be done each morning when the processor is turned on and warmed up, and a log of the testing should be kept. Chemicals should be changed on a schedule recommended by the manufacturer of the processor and whenever the test film falls outside test parameters.

As you can see, many items must be tracked to ensure compliance with state and federal regulations and to keep your clinic safe for your staff and patients. It is critical that you assign a specific staff member or members to each duty and log the results so they can be effectively monitored. Some clinics use a monitor log as a master checklist to ensure that everything is tracked properly. While it may seem like a bit of overkill, no one wants to be in the position where a medical emergency was treated with an expired medication, or a state inspector is at the door and you have no proof that your sterilizers have been monitored. View a sample monitor log.