The need for a ‘Patient Safety in Dentistry Initiative’ in the Gulf States

Abstract

Patient safety is gaining increased attention throughout the world and especially since the establishment of the World Health Organization’s (WHO) World Alliance for Patient Safety (WHO, 2008). However, patient safety in dentistry is still in its infancy. In the Gulf States with the diversity of its dental workforce, many of whom were trained overseas, monitoring adverse incidents in dentistry is essential. The publication in 1999, To Err is Human (Kohn et al., 1999) followed by Crossing the Quality Chasm (Institute of Medicine, 2001) galvanised domestic and international healthcare authorities into prioritising the reduction of iatrogenic harm caused by medical intervention. This mandate was further emphasised by medicine and in particular surgery have embraced the importance of reducing the burden of iatrogenic harm through the development of patient safety reporting systems. Dentistry has lagged behind its medical colleagues in developing patient safety programmes. Some dentists may reflect that issues of patient safety pertain solely to hospital-based medicine and surgery. However, general dentistry does involve penetrating surgery such as implants along with deep injections removal or draining of infections and health monitoring, all of which can and do lead to possible avoidable iatrogenic harm to the patients. With the current trend of more complex dental procedures being undertaken in community-based practices, the potential for iatrogenic harm increases. The need for a country based and in the future a Gulf wide patient safety Reporting and Learning System is needed. In England and Wales, there is one of the largest and most comprehensive reporting systems in the world; it has recorded over 6.7 million incidents over the past 8 years (2003–present) (Lamont and Scarpello, 2009). Staff report incidents through their hospital or primary care organisation so that local action can be taken when needed. These incidents are uploaded to the national database. Healthcare staff, patients, and other members of the public can also report incidents independently through the website. Each National Reporting and Learning System report refers to an unintended or unexpected incident that could have or did lead to harm for one or more patients receiving National Health Service funded care. It includes the reporting of those incidents which did not lead to harm because an error took place but it did not harm the patient, and those which did not lead to harm because an incident was prevented from reaching the patient. These incidents are further stratified into different levels of harm. So what is needed? First, a culture shift in reporting patient safety incidents and doing so to help raise standards in dental care as well as better focused continuing education programmes and the creation of a professional understanding of common errors and incidents in dental provision. Second, strong leadership within the profession to raise patient safety higher up the dental political agenda. Thirdly, sophisticated analyses of these incidents, akin to public health surveillance methods are required to understand the burden of harm in dentistry and develop ameliorative solutions. A Gulf wide Dental Patient Safety Agency’s Reporting and Learning System should be established based upon a web-based open access method whereby the reports are submitted in an anonymous fashion from the individual organisations local risk management system. This would put the region at the forefront of patient safety in dentistry around the world and usher in a new culture of safety into the dental services.