Checklists in Dentistry and Medicine

CHECKLISTs in Dentistry and Medicine.

The use of checklists in medicine and dentistry has evolved over time, and research has demonstrated their effectiveness in improving patient outcomes and enhancing efficiency. Let’s delve into the history and evidence:

  1. Early Beginnings:

Remember that checklists are powerful tools to standardize care, prevent errors, and improve patient outcomes. Their consistent use contributes to safer and more efficient healthcare delivery12.

  1. Surgical Checklists:
  2. Patient Safety and Error Prevention:
  3. High-Reliability Organizations (HROs):
  4. Evidence-Based Practice:
  5. Reporting Guidelines:

In summary, checklists play a vital role in medicine by enhancing safety, reducing errors, and promoting standardized practices. Their continued use and refinement contribute to better patient outcomes and efficient healthcare delivery.

  1. Surgical Safety Checklists:
  2. Clinical Best Practice Checklists:
  3. Standardized Order Set Checklists:
    • Used to ensure consistent application of evidence-based guidelines for specific conditions or procedures.
    • Examples include order sets for sepsis management, postoperative care, and stroke protocols.
  4. Daily Check Sheets:
    • Used to track daily tasks and ensure adherence to best practices.
    • Commonly employed in areas such as ICUs, where timely interventions are critical.
  5. Reporting Guidelines Checklists:
    • Not directly for patient care but crucial for research.
    • Examples include CONSORT (for randomized controlled trials), STROBE (for observational studies), and PRISMA (for systematic reviews).

Remember that checklists are powerful tools to standardize care, prevent errors, and improve patient outcomes. Their consistent use contributes to safer and more efficient healthcare delivery12.

 

  1. Occupational Safety and Health Administration (OSHA) Monthly Checklist:
  2. Monthly Sterilization and Solution Report:
  3. Emergency Medical Kit Checklist:
  4. SteriChek Strips or Sterilizer Monitoring for Spores:
  5. Ultrasonic Cleaning Solutions:
  6. First Aid Kit:
  7. Automated External Defibrillator (AED) Checklist:
  8. Curing Lights:
  9. High- and Low-Speed Handpieces:

Remember that these checklists contribute to patient safety, infection control, and efficient practice management in dental offices. Regular adherence to these protocols is essential for successful clinical outcomes1.

 

Lets take a look at the results of this study that evaluated the use of checklists in simulated Emergency Room Crises…

Medical crisis checklists in the emergency department: a simulation-based multi-institutional randomized controlled trial

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  1. http://orcid.org/0000-0002-5750-0079Eric Dryver1,2,3,
  2. Jakob Lundager Forberg4,
  3. Caroline Hård af Segerstad5,
  4. William D Dupont6,
  5. Anders Bergenfelz2,3,
  6. Ulf Ekelund1,2
  7. Correspondence to Dr Eric Dryver, Department of Emergency and Internal Medicine, Skåne University Hospital Lund, Lund 22185, Sweden; dryver@med.lu.se

Abstract

Background Studies carried out in simulated environments suggest that checklists improve the management of surgical and intensive care crises. Whether checklists improve the management of medical crises simulated in actual emergency departments (EDs) is unknown.

Methods Eight crises (anaphylactic shock, life-threatening asthma exacerbation, hemorrhagic shock from upper gastrointestinal bleeding, septic shock, calcium channel blocker poisoning, tricyclic antidepressant poisoning, status epilepticus, increased intracranial pressure) were simulated twice (once with and once without checklist access) in each of four EDs—of which two belong to an academic center—and managed by resuscitation teams during their clinical shifts. A checklist for each crisis listing emergency interventions was derived from current authoritative sources. Checklists were displayed on a screen visible to all team members. Crisis and checklist access were allocated according to permuted block randomisation. No team member managed the same crisis more than once. The primary outcome measure was the percentage of indicated emergency interventions performed.

Results A total of 138 participants composing 41 resuscitation teams performed 76 simulations (38 with and 38 without checklist access) including 631 interventions. Median percentage of interventions performed was 38.8% (95% CI 35% to 46%) without checklist access and 85.7% (95% CI 80% to 88%) with checklist access (p=7.5×10−8). The benefit of checklist access was similar in the four EDs and independent of senior physician and senior nurse experience, type of crisis and use of usual cognitive aids. On a Likert scale of 1–6, most participants agreed (gave a score of 5 or 6) with the statement ‘I would use the checklist if I got a similar case in reality’.

Conclusion In this multi-institution study, checklists markedly improved local resuscitation teams’ management of medical crises simulated in situ, and most personnel reported that they would use the checklists if they had a similar case in reality.

BYFAVO (remimazolam)(Information obtained and shared from product website https://byfavo.com/ )

Byfavo®: A Short-Acting Sedative for Procedures 30 Minutes or Less

 

Rapid Onset of Action

Onset of sedative effects of 1.0-1.5 minutes1,* and median time to peak sedation was 3.0-3.5 minutes after initial 5 mg dose.2

 

Rapid Offset of Action

Median time to fully alert was 11.0-14.0 minutes following last dose.2

 

Rapidly Metabolized

CYP450-independent metabolism with no active metabolite resulting in a terminal half-life of 37-53 minutes.2

The soft drug approach is a strategy where compounds are specifically designed to be vulnerable to rapid biotransformation into inactive metabolites.3,5

Mechanism of Action

Byfavo is a benzodiazepine. Like other benzodiazepines, Byfavo binds to GABAA receptors in the brain, while its carboxylic acid metabolite (CNS7054) has a 300 times lower affinity for the receptor. Byfavo, like other benzodiazepines, did not show clear selectivity between subtypes of the GABAA receptor.2

Soft, Ester-Based Drug Design

Remimazolam was derived from midazolam.3 The molecular structure of remimazolam differs from midazolam, and all other benzodiazepines, due to the addition of the carboxylic ester linkage.4 The addition of a carboxylic ester linkage creates a “soft drug.”5 The soft drug approach is a strategy where compounds are specifically designed to be vulnerable to rapid biotransformation into inactive metabolites.3,5 This approach was used for the development of remifentanil, a nonhepatically metabolized fentanyl derivative.5,6

byfavo success rate table

Characteristic Benzodiazepine Safety Profile

Established Safety in a Diverse Range of Adult Patients Across 3 Clinical Trials

Common Adverse Reactions Occurring at >2% in Any Treatment Group

Data reflect exposure to Byfavo in 630 ASA I-IV patients pooled from the three placebo-controlled Phase 3 studies.1

 The most common adverse reactions (>10%) in patients receiving Byfavo for procedural sedation were hypotension, hypertension, diastolic hypertension, systolic hypertension, hypoxia, and diastolic hypotension1

Patients receiving Byfavo experienced less hypotension than those receiving placebo with midazolam1

 

https://byfavo.com/dosing-and-administration/

Airway Adjuncts

Airway adjuncts are a class of equipment designed to assist practitioners maintain a patent airway during sedation and or emergency situations.  Nomenclature exists to help distinguish between the different types. There are simple upper airway devices, supraglottic airway aids, and infraglottic airway aids, and endotracheal tubes as well as aids to secure the airway with an endotracheal tube. While there is a range of products to choose from, they all require some understanding, practice, and experience that is essential to gain prior to employing in an emergency or urgent situation. The DSTAR sedation course covers these airway tools and you can practice using them in the live in person sessions.

 The DSTAR sedation course covers these airway tools and you can practice using them in the live in person sessions.

Simple Upper Airway Devices

Simple upper airway adjuncts are utilized to help maintain a patent airway, providing unobstructed air flow to the lungs, either via spontaneous ventilation or Bag Valve Mask ventilation (BVM). Often used as rescue techniques/devices when unable to intubate with standard techniques and difficult to mask ventilate. The two most common and familiar are the Oral Airway (OA) and the Nasal Airway or nasal trumpet. They basically work by stenting open the obstruction in the upper airway which invariably occurs with a reduced level of consciousness, unconsciousness, and general anesthesia, when the base of the tongue falls backwards against the posterior pharyngeal wall in the supine patient.  Oropharyngeal airway placement requires absent gag reflex while Nasopharyngeal airway may be used with an intact gag reflex.

The standard oral or oropharyngeal airways are rigid plastic tubes which are shaped according to the outline of the hard and soft palate as well as the tongue. They have a flange that should rest against the patient’s lips and prevent the device from being inserted too deeply into the mouth. Most manufacturers adhere to a standardized color-coding system of sizes. The typical adult sizes are green (80mm), yellow (90mm), and red (100mm) by increasing size. and treatment planning.

Cone Beam Computed Tomography

In the world of modern dentistry, precision and detailed understanding of a patient’s oral and maxillofacial structures are key to delivering effective treatment plans.

As technology continues to evolve, the use of sophisticated tools like Cone Beam Computed Tomography (CBCT) has become a standard in dental practices worldwide. CBCT, originally developed for use in dentistry in the mid-1990s, allows for accurate three-dimensional scanning of osseous or bony structures within the oral and maxillofacial region.

These scans generate various file formats that carry a wealth of information, integral to dental diagnosis and treatment planning. In scenarios such as implant planning, endodontics, maxillofacial surgery, and orthodontics, traditional 2D images often fall short of providing the necessary depth of information. That’s where CBCT comes in, filling the gap and enhancing diagnostic accuracy and precision.

In this article, we take a closer look at how CBCT files contribute to dental diagnosis and treatment planning and shed light on the different file formats produced by a CBCT scan, underscoring their role in revolutionizing dental care.

CBCT files facilitate surgical planning for procedures such as wisdom tooth extractions, bone grafting, orthognathic surgery, and temporomandibular joint disorder treatment.

Implant Dentistry

CBCT scans enable precise implant planning by assessing bone quality and quantity, identifying vital anatomical structures (such as nerves and blood vessels), and determining the optimal implant size, angulation, and position.

Endodontics

CBCT files help in the management of complex endodontic cases, such as identifying additional canals, detecting root fractures, and assessing the root canal anatomy.

CBCT File Formats in Dentistry

Like 3D printing and CAD/CAM dentistry, CBCT scans can produce various file formats:

  • Digital Imaging and Communications In Medicine (DICOM)
  • Tagged Image File Format (TIFF)
  • Bitmap Image Files (BMP)
  • Joint Photographic Experts Group (JPEG)

DICOM (Digital Imaging and Communications in Medicine)

DICOM or DCM, Digital Imaging and Communications In Medicine file, is known to be the universal file format for 3D CBCT images, both in medical imaging and in dental CBCT. Not only does this format store image data but also relevant patient information and scan parameters for accurate diagnosis and treatment planning.

5 Techniques for Retaining Dental Staff

Running a dental office comes with its challenges, and one of the most prominent revolves around hiring and, more importantly, retaining a competent and motivated team. In fact, staff satisfaction ultimately makes or breaks the overall efficiency of your dental office, as high turnover rates do more than disrupt the workflow. They also impact the quality of patient care.

Therefore, it is critical for dental practices to develop a strong workplace culture that engages its employees. Let us explore effective techniques dentists can adopt to foster a positive working environment and retain dental staff.

1. Competitive Compensation and Benefits

A fundamental strategy for retaining skilled dental professionals is offering competitive salaries and comprehensive benefits. A well-compensated team is more likely to stay committed to the practice.

Therefore, conduct thorough market research to understand the pricing landscape in the local area. Resources such as ADA’s Dental Wage Dashboard, career guides, salary websites, and even job postings from competitors can provide valuable insight. With this, regularly review your dental staff’s salaries and adjust structures as necessary to remain competitive in the market. Additionally, consider offering health insurance, retirement plans, and other benefits to enhance job engagement and employee well-being.

2. Professional Development Opportunities

Investing in the professional growth of your dental staff can be a powerful retention tool. This strategy involves providing opportunities for continuing education, such as attending workshops, participating in training sessions, and obtaining certifications. Not only will this effort enhance the skills of your team, but it will also communicate your commitment to your employee’s career advancement. At the same time, encouraging and supporting staff members’ pursuit of higher qualifications creates a sense of loyalty and mutual investment.

3. Clear Career Pathways

Along with investing in your employee’s professional development, outline clear career pathways within the practice. Employees who can see a future for themselves within the organization are more likely to stay with a dental practice.

Moreover, dentists should have regular meetings with their team members to discuss aspirations and career objectives. Understanding your employee’s career goals allows for better guidance and ensures your employees feel valued. This personalized approach not only aids in staff retention but also enhances job satisfaction and engagement.

4. Create a Positive Workplace Culture

A positive dental workplace culture is essential for ensuring staff happiness and retention. Work towards cultivating an environment that values open communication, teamwork, and mutual respect. Consider organizing team-building activities and social events to strengthen relationships and build camaraderie among staff members.

Also, encourage feedback from your dental staff, whether it is through regular feedback sessions, surveys, or one-on-one discussions. By understanding their pain points, you gain valuable insights into the challenges they face and can work on improving conditions.

5. Flexible Work Arrangements

In a dental practice, work schedule flexibility is a major employee benefit and can help mitigate turnover. So, consider providing options such as flexible hours, compressed workweeks, or remote work options when feasible.

This kind of work schedule enables your dental staff to manage their personal and professional responsibilities more effectively. Not only does this help create a better work-life balance, but it also contributes to a more positive dental workplace and better job satisfaction – all important for retaining staff.

In Conclusion

Retaining a skilled and dedicated dental team requires an employee-centric approach that values the people working to support your goals. From competitive compensation and professional development opportunities to a positive workplace culture, each element contributes to creating a dental workplace where top talent wants to work.

Undoubtedly, dentists who invest time and effort into creating a supportive and growth-oriented environment are more likely to retain dental staff, securing the long-term success of their dental practice.