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ePaper created 2015-05-22, 13:47:53 | version 1.38.0
March 2014United Kingdom Edition12 Perio Tribune page 11DTß include a full periodontal screening, which may not have been done for children and ad- olescents, or patients without their natural teeth remaining. A flow-chart was construct- ed which was followed during the auditing process in order to score each set of notes based on whether sufficient peri- odontal screening had been carried out and whether the correct subsequent non-surgi- cal management was recom- mended or carried out based on the results of the screening. Each of the sets of notes were studied and the flowchart followed in order to grade the overall process of the monitor- ing and managing plaque-re- lated periodontal disease. The flowchart is shown in Ref 1.0. By following the flowchart, each patient’s screening and management was given a score according to the number of correct steps completed. If any step had not been correct- ly completed this was reflected in the scoring system and lead to a lower overall score for the patient’s treatment. A standard BPE was accept- ed as an appropriate screening of periodontal health during a patient’s exam. If a patient had been offered the correct treatment (i.e. it was recommended) according to the findings of their screen- ing, but had refused to accept or failed to attend for treat- ment suggested by the GDP, the practitioner was scored ac- cording the steps taken up to that point in the management of the patient. This was con- sidered acceptable treatment delivered by the GDP as it was the patient’s choice not to un- dergo suggested procedures. Eight patients included in the first cycle and one patient in the second cycle of audit de- clined treatment which was recommended to them. Two patients in the first cycle were found to be edentulous when examining the notes and so were re-selected; none were found to be edentulous in the second cycle. Since the default recall time for patients attending this practice is six monthly, this was accepted as the in- tended follow-up time for a patient where no specific re- call period was stated in the notes. If the patient needed to be seen before this time, it should be written in the pa- tients notes e.g. ‘Follow-up 3-4 months’, or modified on the computer system, which was also checked at time of audit. This would be appropriate for any patients with a BPE of 3, 4, * or with pockets ≥ 4mm, who had undergone plaque-related periodontal treatment for this, in order to monitor healing and observe where further treatment may be necessary. Therefore if, for these patients, a recall period was not stated in their notes or modified on the computer system following treatment, this was seen as in- appropriate follow-up. The type of follow-up treat- ment was not included as part of this audit. This was due to the fact that not enough time would have passed between the start date of the audit and the allocated four week period prior to this, from which pa- tients were chosen, in order for the follow-up treatments to have been carried out. ‘Appropriate’ management of the periodontal condition included further investiga- tions and treatment based on the BPE and was decided upon by amalgamating information from three different sources. A chart was drawn up which indicates the correct man- agement for each particular finding of the BPE screening. This is shown in Table 1.0; the sources are also quoted below the table. This audit included wheth- er a diagnosis was made relat- ing to the periodontal condi- tion. The accuracy of diagnosis in relation to the BPE findings was not investigated as this is outside the scope of the audit. Each grading which was given to a patients periodon- tal treatment according to the flowchart was then put into one of three categories: Gold Standard, Acceptable and Un- acceptable. This reflected the standard of treatment de- livered to each patient. The scores included in each cat- egory and explanations are as follows: Unacceptable= 0-2 Represents patients who hadn’t received an appropri- ate screening at examination, had had no diagnosis made or treatment recommended and hadn’t received correct management for their plaque- related periodontal condition indicated by the screening process. This was deemed an unacceptable level of treat- ment. Acceptable= 3-4 Represents patients who had an appropriate screening car- ried out during their exam and the correct treatment was delivered according to this screening. The ‘Gold Standard’ level was not given to these as some steps along the flowchart had not been followed e.g. di- agnosis or follow-up wasn’t included. However this was not deemed as neglectful on behalf of the GDP as screen- ing and appropriate treatment was still carried out for the pa- tient, and the ultimate goal of diagnosing and managing the patient’s plaque-related perio- dontal condition was reached. Gold Standard= 5 Represents the patients who received completely correct screening and management from their GDP according to the flowchart. The percentage of the over- all sample each category made up was then calculated and this was compared to the ex- pected percentages set out at the start of the audit. Ref 1.1 Table 1.0 Table 1.2 Table 1.1 Sources: Clerehugh, V., Tugnait, A., and Genco, R. J., 2009. Periodontology at a Glance. West Sussex: Wiley-Blackwell The Royal College of Surgeons of England, 2003. Faculty of Dental Surgery: Clinical guideline summaries - Second edition [Online] The Royal College of Surgeons of England. Available at: