Since 1999 there has been growing interest in patient safety in health care. In primary medical care it has been estimated that between 5-80 patient safety incidents occur per 100,000 consultations and that around 11% of prescriptions have errors. However, as yet there seems to be a limited amount of research in dentistry. The aim of this systematic review was to search the academic and grey literature, to identify and assess tools used in dental care to improve patient safety.

Methods

Searches were conducted in Medline, Embase, HMIC, CINHAL and Web of Science databases to identify both published and unpublished reports of studies that use, or describe the development of patient safety interventions relating to dental care.

Studies of any design from any area of dental practice were considered. Relevant organisations, policy makers and regulatory bodies were also contacted. Only studies published after 1980 and published in English were considered.

Outcome measures were: patient safety, harm prevention, risk minimization, patient satisfaction and patient acceptability, professional acceptability, efficacy, cost-effectiveness and efficiency.

Results

• 9 studies were included.
• 4 involved checklists 3, reporting systems, 1 electronic notes and 1 trigger tools.
• The quality of the studies varied and none of their outcomes were verified by other researchers.
• The tools identified have the potential to be used for measuring and improving patient safety in dentistry, with two surgical safety checklists demonstrating a reduction in erroneous dental extractions to nil following their introduction.
• Reporting systems provide epidemiological data, however, it is not known whether they lead to any improvement in patient safety.
• One study on trigger tools demonstrates a 50 % positive predictive value for safety incidents.
• It is not clear as to what impact the introduction of electronic guidelines has on patient safety outcomes.

Conclusions

The authors concluded:

This systematic review finds that the only interventions in dentistry that reduce or minimise adverse events are surgical safety checklists. We believe this to be the first systematic review in this field; it demonstrates the need for further research into patient safety in dentistry across several domains: epidemiological, conceptual understanding and patient and practitioner involvement.

Comments

The reviewers have conducted a broad search of the literature and identified only a handful of relevant studies identified. This is perhaps not unsurprising given the relatively recent focus on this specific are of health care.  As the authors’ note, the skill, experience and up-to-date knowledge of the practitioner supported by regulations, standards and guidelines have traditionally been relied on to ensure safe and effective care for patients.

The conclusions of this review clearly highlight that there is much work that is needed to improve our understanding of the nature and scope of patient safety issues in dentistry and what we can do to educate dentists to improve patient safety. Scotland, which introduced its well-respected Scottish Patient Safety Programme (SPSP) in 2008 initially in the acute services, and subsequently into primary medical care is just starting to engage with primary care dental services so this review, is timely.

Links

Primary paper

Bailey E, Tickle M, Campbell S, O’Malley L. Systematic review of patient safety interventions in dentistry. BMC Oral Health. 2015 Nov 28;15(1):152. doi: 10.1186/s12903-015-0136-1. PubMed PMID: 26613736; PubMed Central PMCID: PMC4662809.

Other references

The Scottish Patient Safety Programme