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Perio Tribune United Kingdom Edition

March 201414 Perio Tribune United Kingdom Edition page 13DTß category, were not deemed as Gold Standard due to the fact that either a diagnosis had been omitted, a follow-up time period had not been recommended, or both. These are the areas which must be looked at in order to im- prove results at the next cycle of audit. There was no specific pat- tern of scores for each individual practitioner. Changes implemented to im- prove overall standard of treat- ment provided: As there was no specific pattern shown from the scores for the different practitioners, it was not deemed appropriate to speak to each individually to improve the results, but to implement a method which would improve the practice’s score as a whole for periodontal diagnoses, management and follow up. With this in mind, a sticker was designed and produced, which was to be stuck in each patients notes who was attend- ing for a regular check-up, and which outlined the key parts of diagnosis, treatment and follow-up for periodontal con- ditions. The sticker designed is shown in Ref 1.2. Using this, each practitioner would be able to concisely and quickly record information re- garding a patient’s periodontal condition at their exam, and would be less likely to forget to include aspects such as a diag- nosis and suggested follow-up period. The sticker is designed to give the practitioner a ‘tick system’ for the management of the patient’s periodontal con- dition. The treatment recom- mended for the BPE scores found are shown in the brackets next to the treatment options, making it easy for the GDP to tick which treatment they rec- ommend the patient should re- ceive according to the BPE score and diagnosis recorded above. There is also an option to circle whether the GDP will carry out the treatment or whether it is to be carried out by the hygienist working at the practice. These stickers were distrib- uted between the four surger- ies and some were also given to the receptionists. Staff, in- cluding the GDP’s, nurses and receptionists, were instructed to put a sticker in a patients notes if they were attending for a check-up only so that this could be completed at their appointment. Following implementa- tion of these stickers into the patients’ notes, the five GDP’s were re-audited four weeks later by again choosing and ex- amining 10 patient’s notes from each GDPs list at random who had attended for an exam and recording the score. As shown by the table (1.2) and the graph below (Ref 1.3), the results from the second cycle of the audit were found to be within the expected val- ues set out at the beginning of the audit, therefore disproving both the null hypotheses. The audit has therefore achieved its aim by improving the over- all standard of monitoring and management of patient’s periodontal conditions at the practice. It was found during the second cycle of audit that where the stickers were used in the patient’s notes, Gold Stand- ard treatment was delivered or planned, resulting in the signif- icant improvement in the find- ings during the second cycle. The next step to improve the results further would be to en- sure that all dentists are using the stickers during every adult patient exam, as where this wasn’t being done, some ele- ments were still being omitted resulting in treatment which was less than Gold Standard. In the future the monitoring and management of periodontal condition will need to be re-au- dited to ensure these standards are maintained and improved on where possible. The results from both cycles can be seen represented in the pie charts in Ref 1.4. Limitations and Improve- ments to the Audit: There are many limitations to this audit and possible im- provements which could be made to refine the results and give a much broader and more accurate representative of peri- odontal screening and treat- ment at the practice. Firstly, a very small sample size was considered. According to the number of patients recorded on the practice system, 50 patients make up about 0.36 per cent of the total patient population of the practice. A much larger sample size would be needed to make the results of the audit more reliable. The presence, or otherwise, of risk factors for periodontal disease was not accounted for in this audit. The aim of the audit was to determine wheth- er the correct non-surgical plaque-related treatment was being carried out for each pa- tient according to the screening results, regardless of the risk factors, e.g. medical conditions, medications and smoking sta- tus. It was assumed that these risk factors were observed by the GDP and discussed or in- vestigated accordingly. Also, the precise diagnosis arrived at for each patient was not inves- tigated. The audit only looked at the basic principles of man- agement of plaque-related per- iodontal condition according to the findings of the BPE and the diagnosis given, assuming this diagnosis was correct. If a patient suffered from any con- dition other than plaque-in- duced generalised gingivitis/ periodontitis, this was not ac- counted for. Radiographs were not in- cluded in the ‘further investiga- tions’ section as it was assumed these were taken at the time of examination and they were appropriate to the periodontal condition. This would be an- other area to expand the scope of the audit. To improve the audit and make the results more valid, the extent of treatment provid- ed should be further scrutinised to include whether the diagno- sis made was correct according to the findings of the screening, and whether treatment took into account associated risk factors as well as oral hygiene factors alone. The difficulty with investigating a practition- er’s diagnoses is that these can be very subjective and can vary from dentist to dentist. It would be hard to judge whether a practitioner had made the correct diagnosis based on retrospective investi- gation of a patients notes alone and without examining the pa- tient. It is likely that more than one investigator would need to carry out the audit and inter- and intra-examiner calibration would need to be done in order for this to be reliable and valid. This is another improve- ment which could be picked up on with the current audit; only one examiner carried out the audit. This person may have had different judgements on whether the notes displayed ‘correct’ or ‘appropriate treat- ment’ according to the chart and flowchart which were followed when carrying out the audit. Again, it would be improved by having a second examiner pre- sent when auditing the patient’s notes, giving the opportunity for discussion and in order that a more rounded decision is made if there is any query over the treatment provided. For the patients who re- fused to accept or commence appropriate treatment based on their BPE score, it was as- sumed that the practitioner ex- plained the risks of not having the treatment suggested to the patient, and that this was suffi- cient enough for the patient to understand. For completeness, this aspect should be checked from the notes taken on the day to ensure these patients were able to make an informed deci- sion on the treatment they had chosen to opt out of. It was noted by members of staff at the practice that the stickers used to improve the re- sults were a costly way of doing so, due to the expense of pur- chasing the stickers and then printing the design onto them. Following a successful trial pe- riod of the stickers use in pa- tients’ notes at the practice, it may be more cost-effective to create a stamp which includes the information on the sticker, and use this to create the same template in patients’ notes in- stead. With this method, staff and GDP’s at the practice would be able to use the stamp multi- ple times, with only the initial expense of the stamp itself and occasional cost of ink pads. Conclusion: Periodontal disease is becoming increasingly prevalent amongst today’s population due to, amongst other factors, people living for longer and maintain- ing their natural teeth later into life. For this reason it is essential to identify and manage any peri- odontal conditions as early as possible in the disease process in order to delay the deleteri- ous effects of the condition and prevent it progressing further. In order to do this, we as dental professionals must have simple and effective methods of re- cording periodontal screenings and diagnoses so that we may recommend and deliver appro- priate treatment to patients for these periodontal conditions. As demonstrated by the implementation of a simple pro-forma during a patient ex- amination, in this case in the form of a sticker, periodontal screening and management can be greatly improved. This template quickly and effec- tively allows the practitioner to cover all relevant areas of peri- odontal screening and manage- ment and means it is less likely that any essential components will be omitted from the pro- cess. With a reliable and re- producible procedure such as this in place, the periodontal condition of patients attend- ing the practice is more likely to remain healthier for longer. This will subsequently improve the prognosis of all other den- tal procedures delivered by the GDP, giving the patients a bet- ter quality of care overall. DT ‘Periodontal disease is becoming increas- ingly prevalent amongst today’s popula- tion due to, amongst other factors, people living for longer and maintaining their natural teeth later into life’ Ref 1.3 Ref 1.3 Graph showing expected ranges of each category and actual percentages for second cycle Ref 1.4 Results from Cycle 1 and 2 represented in pie charts Ref 1.4 About the authors Catherine Turner BChD (Leeds) DF Trainee Bedford Scheme (Health Education East of England) Victor Gehani BDS. MFDS RCS (Eng). MFGDP(UK). DPDS (Bristol). PG Cert (Med and Den Ed). FHEA. FICOI. MSc Implant Dentistry (Warwick). FIADFE. PG Cert Rest Dent (UCL). DF Trainer Bedford Scheme (Health Education East of England) Patch Associate Dental Dean (North Central London) Health Education England, London Dental Education and Training. Sabina Wadhwani BDS (U.Lond). MFGDP(UK). PG Cert (Med and Den Ed). FHEA. PG Cert (Mentoring). DF Trainer Bedford Scheme (Health Education East of England)

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