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Errors and adverse events in dentistry – a review

From Volume 44, Issue 10, November 2017 | Pages 979-982

Authors

Simon Wright

BDS, MSc, PGCTLCP FHEA, PGDip Implant Dentistry

Programme Lead, Faculty of Health and Social Care Edge Hill University; Director of ICE Postgraduate Institute and Hospital, Salford Quays M50 3XZ, UK

Articles by Simon Wright

Gillian Crofts

PhD, MSc

Director of Education ICE Postgraduate Dental Institute and Hospital, Salford Quays M50 3XZ, UK

Articles by Gillian Crofts

Cemal Ucer

BDS, MSc, PhD

Clinical Lead, Faculty of Health and Social Care Edge Hill University; Director of ICE Postgraduate Institute and Hospital, Salford Quays M50 3XZ, UK

Articles by Cemal Ucer

David Speechley

BDS, DMI RCS(Edin), MSc, PGDip Implant Dentistry

Mentor Lead, Faculty of Health and Social Care Edge Hill University; Director of ICE Postgraduate Institute and Hospital, Salford Quays M50 3XZ, UK

Articles by David Speechley

Abstract

As dental professionals we must change the way we think about error. By adopting a more positive, constructive approach, centred around analysing why errors happen, we can then accept our vulnerability and design systems and protocols to prevent errors from occurring. Errors are inextricably linked to human behaviour. Human factors in healthcare are concerned with ensuring patient safety through promoting efficiency, safety and effectiveness by improving the design of technologies, processes and work systems. Essentially, this embraces standardization and involves examining and designing out error.

Health Education England has highlighted education in ‘human factors’ as a priority workstream, however, there are many impediments to progress as system changes are slow and difficult to implement. This effectively means that, at present, it is up to individual practitioners to introduce the concept of human factors into their practices. A number of factors have been identified that are critical to reducing error, namely teamwork, communication, leadership and fatigue. Furthermore, a number of strategies have been implemented in secondary care to help reduce the risk of error, including effective leadership, specific policy and procedure, and monitoring and measuring compliance.

The majority of the causes of error are related to human factors rather than technical ability or inadequate knowledge. This has major implications for primary care practice, as currently we are concentrating our professional development on the use of technology and our intellectual capabilities, rather than implementing education within, and the development of, human factors. It is our recommendation that human factors form part of our undergraduate teaching and core CPD (Continued Professional Development).

CPD/Clinical Relevance: There needs to be a paradigm shift from a culture of blame to a just culture, where it is accepted that, despite our experience, character and talents, we are going to commit errors.

Article

The dental practitioner has historically been considered to be efficacious. Dealing with the most intimate aspects of human life is not without error and, ultimately, this may lead to consequences that impact on patient safety for which the dental practitioner is held accountable.1

As Nolan2 points out, most errors are attributable to human factors. Dentistry, by its very nature, involves complex manual tasks performed to a high degree of accuracy with high risk for error. Refusal to acknowledge that we will make errors not only compromises patient safety, but also limits professional performance.1 The sentiment in dentistry, however, is starting to change, with more focus on system analysis rather than placing blame solely on the practitioner.3,4

Ideally, we should be aiming to reduce risk in the context of performance. Nolan advocates designing safe systems based on human factors, to reduce error to zero. Whilst zero error rate is practically unlikely to be achieved, professionals can, and must, change the way they think about error. By adopting a more positive, constructive approach, centred around analysing why errors happen, we can then accept our vulnerability and design systems and protocols to prevent errors from occurring.

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