HIW Dental Practice Inspections Rebecca Jewell Primary & Community Healthcare Manager, Healthcare Inspectorate Wales Ali Jahanfar, Peer Reviewer 1
About HIW Who we are HIW is the independent inspectorate and regulator of all healthcare in Wales What we do We review and inspect NHS and independent healthcare organisations in Wales to provide independent assurance for patients, the public, the Welsh Government and healthcare providers Our purpose To provide the public with independent and objective assurance of the quality, safety and effectiveness of healthcare services, making recommendations to healthcare organisations to promote improvements. 2
Our values • Patient-centred: we place patients, service users and public experience at the heart of what we do • Openness and honesty: in the way we report and in all our dealings with stakeholders • Collaboration : building effective partnerships internally and externally • Professionalism : maintaining high standards of delivery and constantly seeking to improve • Proportionality: ensuring efficiency, effectiveness and proportionality in our approach 3
Our outcomes Provide assurance: Provide independent assurance on the safety, quality and availability of healthcare by effective regulation and reporting openly and clearly on our inspections and investigations. Promote improvement: Encourage and support improvements in care through reporting and sharing good practice and areas where action is required. Strengthen the voice of patients: Place patient experience at the heart of our inspection and investigation processes. Influence policy and standards: Use our experience of service delivery to influence policy, standards and practice. 4
Our Work 5
Give Clear Reassurance that: 1.This is not intended to be a ‘Gestapo’ type experience 2. Much more a discussion between professional colleagues 3. We are listening to your comments and experiences and acting upon them – where appropriate 4. We are refining our processes 6
The Visit Workbook Components • 1. Patient Experience • 2. Management and Leadership • 3. Written Documents • 4. The Environment – internal and external premises • 5. Standards (IRMER, Medical Emergencies and Waste • 6. Decontamination Processes • 7. Clinical Facilities • 8. Patient Records 7
The Inspection Team The Inspection Manager & The Clinical Reviewer 8
HIW Dental Inspection Programme – the journey so far… • Stakeholder Reference Group established including representatives from LHBs, WG, PHW, BDA, GDC and Deanery • Methodology and reporting style developed • Clinical Dental Lead (Dr Brent Weller) and Dental Reviewers appointed • Pilot inspection undertaken to test HIW’s inspection processes • 2014/15 inspection programme – 75 practices inspected • 2015/16 inspection programme – 133 practices inspected 9
Dental Inspection Programme – the journey so far… • Positive impact and engagement • Findings used by Wales Postgraduate Deanery, Public Health Wales and Welsh Government • First annual report published in June 2015 • Second annual report to be published summer 2016 10
HIW Dental Inspection Programme – the process BEFORE THE INSPECTION: • 8 weeks notice by letter • ‘What to expect from an inspection’ guidance • List of documents for inspectors to view • Patient Questionnaires • Telephone call approximately one week before from inspector • www.hiw.org.uk/dental-services - workbook and guidance 11
HIW Dental Inspection Programme – the process THE DAY OF THE INSPECTION: • Inspection team - HIW inspection manager + dentist • One day on site • Complete inspection workbook – Observe (eg decontamination process) – Talk (speak to patients and all staff) – Check (documentation and records) • Immediate verbal feedback 12
The role of the Peer Reviewer • The Peer reviewer inspects the following areas • Radiographic equipment & documentation • Including the Radiation Protection File, • The radiation equipment certification for each machine, • Quality assurance audits • Records of Radiation Protection Training (IRMER)
Radiography Issues • Registration of equipment • Age of equipment • Condition • Location relative to staff/patient positioning? • Local rules • Appointed persons? 14
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Radiography Issues – Quality Assurance • QA 1,2,3 recording and auditing • Diagnostic reporting in patient notes • Film storage if ‘wet’ films • Data back up if digital • Start of day wedge testing? 17
Daily Wedge Tests? 18
The role of the Peer Reviewer • The Peer reviewer inspects the following areas • Resuscitation and First Aid • Practice resuscitation policy • Up to date training in CPR • Appointed first aider • Does the practice has adequate resuscitation equipment? • Are all emergency drugs within date? • Log book to show regular checks of emergency drugs and resuscitation equipment. • What systems are in place to ensure the security of drugs and prescription pads?
The role of the Peer Reviewer • The Peer reviewer inspects the following areas • Decontamination of instruments and compliance with WHTM01-05 • Daily maintenance programme including log books for checking each autoclave, start and end of day checks. • Pre-cleaning methods • Washer – disinfector • Ultrasonic bath • Manual cleaning • Instrument storage including transport between surgeries and decontamination room • Hand washing facilities available? • Designated contamination room available? • Decontamination training protocol with individual records • Routine audits of infection control requirements WHTM01-05 • Inspection certificates for autoclaves
Cross Infection Control • Basic cleanliness issues • Work surfaces clear • Sealed surfaces • Sealed flooring • Important to separate what is essential and what is advisable/desirable/ ‘Gold Standard’ 21
Clutter – worth commenting on but hardly a reportable issue! 22
Rethinking and tidying needed 23
Less Clutter 24
Wipe clean keyboard 25
Cross Infection Control • AUTOCLAVE ISSUES • Type B, N or S? • (B- pre-wrapped and storage 12 months) • (N- post wrapped and storage 12 months) • (S- see manufacturer’s guidance) • Type B may be best but not compulsory 26
Autoclaves • Location • Use of a ‘Sterilising room’ / CSSD • Autoclaves still in surgeries? 27
Clear Labelling and Expiry Dates 28
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We All Make Mistakes!! 31
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Pre- Autoclave Cleaning Process • Pre soaking? • PPE • Ultrasonic cleaning • Manual cleaning • Visual Inspection – good light + magnification • Use of washer-disinfectors? 34
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Clear Visual Inspection 37
Hand Cleaning and Instructions 38
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Post Sterilisation Storage • Where? • How long? 40
Storage away from surgery - labelled 41
Autoclaving of Ultrasonic Tips AND Handpieces 42
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The role of the Peer Reviewer • The Peer reviewer inspects the following areas • Handling, storage and disposal or clinical and non-clinical waste • Contracts in place for clinical waste, amalgam waste, sharps, non-clinical waste • Where is the clinical waste stored? • Is the clinical waste stored securely? • What happens to unused medicine? • Extracted teeth with/without amalgam • Domestic waste such as black bags • Amalgam separators installed?
Waste Storage • Clinical waste • Contaminated • Teeth • Amalgam waste • Amalgam capsules • Lockable storage? 46
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Sharps • Management • Needle resheathing? Or not? • Holders • Sharps containers and location 49
The role of the Peer Reviewer • The Peer reviewer inspects the following areas • Clinical Facilities • Dental Surgeries • Dental unit and cabinetry in good condition? • Is the surgery clean? • X-ray equipment • Local rules visible • Film holding kit available • Dental Equipment and Instruments • Sufficient number of fast, slow and straight handpieces • Ultrasonic scaler and tips • Surgical kit • Filling mixer • Disposable or single use items. • Regular serving of compressor
Audit • Recording of audits • Which are being done? • Which are essential • NB some contain confidential data that we do not need to view 51
CPD Records • Should be recorded • And available on the day to view • Staff training and updates • CPR Training – when and who? • Defibrillator - Compulsory or not? 52
BPEs and Periodontal Care • Ensure that • 1. BPEs are being recorded and updated • 2. Treatments prescribed match the BPE score 53
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