Army Dental Corps sets high goals for patient safety

Fort Sam Houston, Texas鈥?The Army Dental Corps has sights set on a “no blame” culture of patient safety in military clinics at home and abroad. “A Full Time Commitment, Not A Part Time Practice,” says a promotional poster.

“With Fort Bragg DENTAC’s commitment to TeamSTEPPS (a commercial training aspect of the patient safety effort) the vision is becoming a reality,” said Col. Mary Jo Corbett, D.D.S. “This plan is not promoted as an initiative鈥?this is the way that we do our mission every day to take care of soldiers.” Dr. Corbett is the Fort Bragg, N.C., patient safety manager. DENTAC is one of 30 dental activities under the Army dental command (DENCOM).

Army patient safety representatives describe a system that is on the ground and running but still in infancy, created “to identify and mitigate error events” by communicating and sharing information and learning from those errors. Training is but one aspect. A Web-based monthly reporting system is already producing trend data, they told the ADA News.

“Through the leadership of the DENCOM commander, Col. Larry Hanson, the dental patient safety program has been elevated to a high level of visibility with an open and no blame culture,” the patient safety representatives said. “This type of culture encourages subordinates to speak up without fear of punishment or blame when errors occur.” Training emphasizes use of a two-challenge method applicable to any clinic procedure. But challenges in the operatory, they concede, may require a culture change whatever reporting tools are in place.

“It’s going to take 10 years to change a culture and reach maturity. As the program advances, we are learning from our errors and driving up the standard of excellence that we already enjoy,” said Col. Ann S. von Gonten, D.D.S., a dental consultant for the effort. “We’re not selling a product, we’re selling a change of culture,” added Maj. Tim Fildes, a British Royal Army exchange dental officer on assignment with the U.S. Army “to help with the patient safety movement.”

Patient safety vignettes are in preparation to enhance clinical training, said Robbie Sjelin, Department of Defense dental patient safety consultant and a dental hygienist and registered nurse.

Under the system, clinics report near miss and actual safety events monthly to a patient safety center. Patient safety representatives claim to have 100 percent reporting from all 30 dental activities within the command but this may not necessarily include every one of the 155 dental clinics and the one dental laboratory.

The Web-based reporting system lists nearly 80 “administrative” through “wrong site” events with an option to “check here if this facility has no events to report.” The reporting system is already producing results. “The more data we get the more we can see trends,” said Dr. von Gonten. “For example, we’re finding a lack of standardization of correct sterilization procedures.” These findings are communicated up and throughout the dental command chain.

“The events are analyzed with the goal of improving systems and processes of care, the patient safety representatives said. “Dental activity sites recognize that when errors occur, individual occurrences have less impression and impact as when the data are collated with similar events from other facilities, tracked, trended and shared with all.”

A “Time Out” initiative engages patients in the safety movement. “The whole time out process is intended to ensure that the right patient gets the right treatment at the right time with all the right equipment,” said Lt. Col. Andrew J. Wargo, D.D.S., the Army dental officer who created the “Time Out!!” posters on display in patient areas throughout the dental command. The posters advise patients: “To ensure that you are receiving the proper treatment, please make sure your doctor confirms who you are and why you are here.”

Patients with similar names or identification numbers are at greater risk of receiving dental treatment that was scheduled for other patients, the patient safety representatives told the ADA News. “The Time Out verification is a fail-safe ‘No-Go’ model where all participating team members check and agree as a team that a set of essential safety elements are present prior to an invasive procedure or treatment.”

An unclassified Jan. 21 dental command briefing reported 8,100 patients seated, 24,300 dental procedures performed and $2.4 million in dental care provided on “An Average DENCOM Day.”

This includes 4,600 X-rays, 2,600 amalgam and resin restorations, 1,400 cleanings and fluoride treatments, 385 mouth guards, 106 root canals, 75 periodontal surgery procedures, 610 periodontal cleanings, 655 extractions, 70 gold crowns cemented, 25 porcelain crowns cemented, 13 complete and partial dentures inserted and 350 nutrition and 200 tobacco counseling sessions.

There are 1,022 dentists in the “DENCOM family,” including 722 active duty dental corps officers, 51 Army civilian dentists and 249 contract dentists.