Research Projects in Medical Sciences

Assessing Patient Safety in Dentistry

Faculty: Elsbeth Kalenderian, DDS, MPH, PhD
Funder(s): OHPE Department

A variety of expensive and largely ineffective methods have been used in medicine to identify AEs, including chart audits and malpractice claims review. There is little knowledge about the type and frequency of adverse events (AEs) in dentistry, with particularly a dearth of information in academic settings. The goal of this research was to 1) assess patient safety culture of faculty, hygienists, students and staff from three dental schools, 2) analyze FDA MAUDE (Manufacturer and User Facility Device Experience) database that represents device-related AE reports, and 3) conduct trigger chart reviews to identify AEs that may occur in academic dental settings.
Overall, our adapted Medical Office Survey on Patient Safety Culture showed that dental settings rated ability preventing AEs as excellent/good at 31% while medical settings rate themselves at 64%.
Analysis of MAUDE (1994-2011) revealed 2,017,966 AEs, of which 29,427 were related to dental devices (1.45%). Of those, 72 (0.24 %) resulted in death, 20,139 (68.44 %) in injury and 7003 (23.80%) caused malfunction. Endoesseus implant-related devices were linked to the majority (61%) of the AE reports. 
Three triggers (I&D, failed implants, multiple restorative providers) were used as part of an electronic chart review tool. In total 87 charts were triggered, of which 54 were positive for one or more AEs. Most AEs caused temporary harm, but nine were considered to have caused permanent harm.
Our results suggest the need for dental institutions to improve the patient safety culture; focus on devices that may cause AEs; and the use “triggers,” or clues, to identify AEs from chart reviews may be a promising method for measuring the overall level of harm from care.
References
1. Taichman, R.S., et al., Prospective identification and skeletal localization of cells capable of multilineage differentiation in vivo. Stem Cells Dev, 2010. 19(10): p. 1557-70.
2. Agency for Healthcare Research and Quality, Medical Office Survey on Patient Safety Culture, J. Sorra, M. Franklin, and S. Streagle, Editors. 2008, Agency for Healthcare Research and Quality: Rockville, MD.
3. Gurtcheff, S.E., Introduction to the MAUDE database. Clin Obstet Gynecol, 2008. 51(1): p. 120-3.
4. Institute of Medicine, Crossing the Quality Chasm. A New Health System for the 21st Century. 2001, Washington: National Academy Press.
5. Leape, L.L., et al., Reducing adverse drug events: lessons from a breakthrough series collaborative. Jt Comm J Qual Improv, 2000. 26(6): p. 321-31.
6. Jha, A.K., et al., Identifying adverse drug events: development of a computer-based monitor and comparison with chart review and stimulated voluntary report. J Am Med Inform Assoc, 1998. 5(3): p. 305-14.
7. Resar, R.K., J.D. Rozich, and D. Classen, Methodology and rationale for the measurement of harm with trigger tools. Qual Saf Health Care, 2003. 12 Suppl 2: p. ii39-45.
8. Chambers, D.W., Risk management. The Journal of the American College of Dentists, 2010. 77(3): p. 35-45.
9. Trigger tool for measuring adverse events.  01/23/2012]; Available from: www.ihi.org.