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Dental Squared Flashcards

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1
Q

What is the definition of clinical governance?

A

Clinical governance refers to how the NHS maintains and improves the quality of care for patients. It ensures accountability in providing high clinical standards and promotes a culture of excellence and continuous improvement in healthcare.

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2
Q

What are the 7 pillars of clinical governance?

A
  • Patient and public involvement – involving patients in service development.
  • Clinical effectiveness – using the best available evidence to deliver care.
  • Risk management – identifying and mitigating patient safety risks.
  • Clinical audit – reviewing practice against standards.
  • Staff and workforce management – ensuring fair recruitment and proper support.
  • Education and training – maintaining and developing professional knowledge.
  • Information and IT – safe handling and confidentiality of patient data.
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3
Q

What are examples of additional components of clinical governance?

A

Infection control, safeguarding, radiology access, and ensuring data confidentiality.

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4
Q

What is evidence-based dentistry?

A

It is the use of the best available dental evidence derived from high-quality research to provide optimal care for patients.

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5
Q

How does an audit differ from research?

A

Research helps establish best practice, while an audit checks whether current practice meets that standard.

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6
Q

What is the hierarchy of evidence?

A
  • Meta-analyses & systematic reviews (strongest)
  • Randomised Controlled Trials (RCTs)
  • Observational studies (e.g., cohort, case-control)
  • Case studies
  • Expert opinion (weakest)
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7
Q

What are the key features of Randomised Controlled Trials (RCTs)?

A

RCTs randomly allocate interventions, often with blinding and large sample sizes, to minimize bias and confounding factors.

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8
Q

What are the disadvantages of observational studies?

A

They cannot control group allocation, making them prone to confounding variables and lower reliability than RCTs.

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9
Q

What is a case study and what are its limitations?

A

A case study is a detailed report on one patient. It is anecdotal, qualitative, not generalizable, and lacks statistical significance.

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10
Q

What is expert opinion in the context of evidence?

A

Expert opinion is based on personal experience and lacks statistical analysis, controls, or large sample sizes. It’s the lowest level of evidence.

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11
Q

What are good sources of clinical evidence?

A

Cochrane Library, FGDP, SDCEP, and the “Delivering Better Oral Health” toolkit.

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12
Q

What is a clinical audit?

A

A clinical audit is a tool used to assess how well current practice compares to best practice. It reviews care and implements improvements where necessary.

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13
Q

How is an audit different from research?

A

Research is used to establish best practice, whereas an audit checks if current practice meets that best practice.

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14
Q

What are the steps of the audit cycle?

A
  1. Identify an issue or problem.
  2. Set the standard based on guidelines.
  3. Collect initial data (1st audit cycle).
  4. Analyse the data against the standard.
  5. Make necessary changes.
  6. Re-audit to assess improvements (2nd audit cycle).
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15
Q

What are the limitations of audits?

A
  • Small sample sizes
  • Resistance to change
  • Not closing the loop
  • Mostly retrospective in nature
  • May cause demotivation or tension
  • Short duration for trainee audits
  • Trainees may lack authority to implement change
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16
Q

What is risk management in healthcare?

A

Risk management involves identifying potential risks to patients and putting measures in place to reduce the chance of those risks causing harm.

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17
Q

What is a Significant Event Analysis (SEA)?

A

SEA is a method used to review and analyze adverse or unexpected events in healthcare to identify causes and prevent recurrence.

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18
Q

What are the 5 steps of a Significant Event Analysis?

A
  1. Describe what happened.
  2. Analyze why it happened.
  3. Assess potential impact.
  4. Reflect on and learn from the event.
  5. Plan future changes to prevent recurrence.
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19
Q

What framework can be used to understand why an event occurred?

A

The Yorkshire Contributory Factors Framework, which includes:
- Organisational factors
- Team factors
- Communication and culture
- Human factors
- Patient factors
- Task factors

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20
Q

What is root cause analysis?

A

A technique to identify the underlying cause of an incident by asking ‘why?’ repeatedly until the fundamental issue is found.

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21
Q

Give examples of organisational and human factors that contribute to risk:

A
  • Organisational: Poor training, staff shortages, IT failures
  • Human: Fatigue, inexperience, stress
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22
Q

What actions should follow risk identification?

A
  • Introduce protocols or checklists
  • Provide additional staff training
  • Use IT systems to prevent documentation errors
  • Ensure continuous monitoring and feedback
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23
Q

What is the importance of training and education in dentistry?

A

It ensures that dental professionals maintain and develop relevant knowledge and skills throughout their careers. This is achieved through CPD, which is a GDC requirement.

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24
Q

What are the 4 areas of CPD development?

A
  1. Knowledge and clinical skills
  2. Professionalism
  3. Effective communication
  4. Leadership and teamwork
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25
What is the GDC CPD cycle?
1. Plan – identify learning needs and create a PDP. 2. Do – undertake activities to meet these needs (courses, tutorials, readings). 3. Reflect – evaluate what was learned and identify further needs. 4. Record – document all CPD activities and link them to PDP and developmental outcomes.
26
What is a Directly Observed Procedural Skill (DOPS)?
A method to assess a dental professional’s competence during a clinical procedure, using observation and structured feedback, often via a checklist.
27
What is Pendleton’s Feedback Model?
1. Learner: what went well 2. Teacher: what went well 3. Learner: what could improve 4. Teacher: what could improve 5. Clear and agreed change
28
What is reflective practice?
Reflective practice involves thinking about personal experiences to learn and improve performance and patient care. It enhances professional development and patient outcomes.
29
How does reflective practice improve personal development?
- Helps manage stress and well-being - Identifies trends and areas for improvement - Encourages asking for help - Supports career progression
30
How does reflective practice improve patient care?
- Reduces errors - Promotes safer, more effective care - Encourages learning from past cases
31
What are examples of reflective practice formats?
- Case-based discussions - Feedback from peers or supervisors - DOPS evaluations - Informal reflections with educational supervisors
32
What is the Gibbs Reflective Cycle?
1. What happened? 2. Reactions and feelings 3. What was good and bad? 4. Make sense of the situation 5. Identify learning points 6. Plan future actions for improvement
33
What is the definition of consent in dentistry?
Consent is the voluntary and informed agreement by a patient to undergo a specific treatment, test, or examination. It must be valid, informed, and ongoing.
34
What are the key elements for valid consent?
- Patient understands options, risks, benefits, necessity, and prognosis - Clinician gives a recommendation - Costs (if any) are explained - All discussions are documented
35
What is the Montgomery ruling?
A legal precedent stating that clinicians must inform patients of any risk that a reasonable person in the patient’s position would want to know before consenting.
36
What are the criteria for assessing patient capacity?
1. Understand the information 2. Retain the information 3. Weigh the information 4. Communicate a decision
37
What should be done if a patient lacks capacity?
Make decisions based on their best interest using the least restrictive option, involving: - Family or next of kin - Lasting Power of Attorney (LPA) - Independent Mental Capacity Advocate (IMCA)
38
When is written consent mandatory?
For treatments involving conscious sedation or general anaesthesia.
39
What is Gillick competence?
A principle where a child under 16 can consent to their own treatment if deemed mature enough to fully understand the implications.
40
Can patients withdraw consent?
Yes, patients can refuse or withdraw consent at any time, even during treatment.
41
What is safeguarding in dentistry?
A set of procedures and responsibilities aimed at protecting vulnerable individuals (e.g., children, elderly, or those with mental illness) from abuse, neglect, and harm.
42
Who is considered a vulnerable person?
Someone unable to protect themselves due to age, disability, illness, or mental health issues.
43
What are the 4 main types of abuse?
1. Physical – e.g., bruises, fractures 2. Emotional – e.g., withdrawal, low confidence 3. Sexual – e.g., inappropriate behavior, UTIs 4. Neglect – e.g., poor hygiene, caries, hunger
44
What are the GDC's safeguarding requirements?
- Raise any concerns of abuse or neglect - Know how to contact local safeguarding leads - Follow local protection procedures - Report appropriately and without delay
45
What are the levels of safeguarding response?
- Level 1: No additional needs - Level 2: Early Help and Prevention Services - Level 3/4: Statutory intervention, e.g., Child Protection Plan
46
What is the role of Early Help services?
To provide support (e.g., family therapy, social workers) to address concerns early and prevent escalation.
47
What is the Duty of Candour?
It is the ethical and legal obligation to be open and honest with patients when something goes wrong that causes or could cause harm or distress.
48
What are the 4 steps outlined by the GDC for Duty of Candour?
1. Inform the patient about what happened, using clear, non-jargon language. 2. Offer a sincere apology. 3. Explain the short- and long-term effects of the incident. 4. Offer appropriate remedies and participate in investigations.
49
When should you disclose an error to a patient?
As soon as reasonably possible after realizing the error has occurred.
50
What is patient confidentiality?
The duty to keep all patient information private and secure, including conversations, records, and test results.
51
When can confidentiality be breached?
- Legal obligation - Serious risk of harm to the patient or others - Safeguarding concerns - With patient’s consent
52
What is GDPR and how does it apply to dentistry?
The General Data Protection Regulation sets rules on processing and storing patient data: - Must be transparent, accurate, secure, and for legitimate purposes.
53
What does the DPA 2018 say about data use?
Information must be used fairly, lawfully, and transparently.
54
How should dental professionals manage images and recordings?
- Must obtain patient consent, preferably written - Do not share on social media unless explicitly permitted - Store securely and encrypt digital files
55
What is the GDC guidance on confidentiality for adults and children?
- Adults: Never disclose without consent unless risk of serious harm. - Children: Always consider safeguarding; Gillick-competent children can consent for themselves.
56
What is the GDC’s Principle 8 about raising concerns?
It emphasizes acting immediately when patients or colleagues are at risk and ensuring a culture of open and safe reporting without fear of reprisal.
57
When should a concern be raised to the GDC directly?
- Local resolution is not practical or has failed - The issue is severe (e.g., indecency, dishonesty, violence) - There’s a genuine fear of retaliation or concealment
58
What is the recommended escalation ladder for raising concerns?
1. Approach the colleague if appropriate 2. Escalate to supervisor, ES, safeguarding lead, or management 3. In severe cases, report directly to GDC or external bodies (e.g., Police)
59
What is Protect?
A whistleblowing charity that offers confidential advice to professionals afraid to raise concerns within their workplace.
60
What must you do if you fail to raise a concern?
You could risk your GDC registration, especially if patient safety is compromised.
61
What is the GDC's guidance on using social media?
Dental professionals must maintain patient confidentiality, avoid posting anything that undermines public confidence, and refrain from misleading advertising.
62
Can patient images be posted on social media?
Only with explicit patient consent. Specify how and where the image will be used. Written consent is strongly recommended.
63
What are the GDC rules on advertising as a 'specialist'?
Only dentists registered on the GDC Specialist Register may use the title 'specialist.' Others may say they have a 'special interest' but not advertise as specialists.
64
What should you do when handling a patient complaint?
1. Manage any immediate clinical risk. 2. Gather information (speak to patient, review notes, involve staff). 3. Acknowledge complaint within 3 working days. 4. Provide a timely, constructive response. 5. Offer solutions or signpost to services like PALS or the GDC.
65
What is a constructive response to a complaint?
- Avoid being defensive - Apologize if appropriate - Empathize with the patient's experience - Offer practical solutions - Keep the patient updated (every 10 days if delays)
66
What should you do if the complaint involves a colleague?
- Avoid apologizing on their behalf - Let them respond directly if possible - Acknowledge the event but focus on resolving it appropriately
67
What does the GDC say about complaints?
Complaints are opportunities to learn and improve. Analyze them, share lessons with the team, and document everything thoroughly.
68
What is professionalism in dentistry?
It refers to maintaining ethical behavior, honesty, integrity, empathy, and respect in interactions with patients, colleagues, and the public.
69
What behaviors reflect professionalism?
- Effective, respectful communication - Maintaining boundaries with patients - Dealing appropriately with stress - Demonstrating honesty in clinical and financial matters
70
What does the GDC expect regarding professionalism?
- Treat all individuals fairly and legally - Avoid public criticism of colleagues - Avoid social media posts that harm public trust - Uphold patient safety and professional boundaries
71
Why should dentists avoid treating family or close friends?
Relationships may impair professional judgment and lead to blurred boundaries or unrealistic expectations.
72
What does the GDC say about working within your scope?
- Only carry out treatments you're trained and indemnified for. - Refer to colleagues when beyond your competence. - Maintain knowledge through CPD and lifelong learning. - Base treatments on current evidence and justify any deviations.
73
What is the ABC approach in emergency dental management?
A – Airway: Ensure it's clear; if compromised, call crash team immediately. B – Breathing: Assess breath sounds, oxygen saturation, need for oxygen. C – Circulation: Check blood pressure, heart rate, skin color for perfusion issues.
74
What should you do if the airway is compromised?
Call a crash team and get an on-call anaesthetist to secure the airway immediately.
75
What signs suggest circulatory instability?
- Low BP - High HR - Cold, mottled, or blue skin
76
What is sepsis?
A life-threatening condition caused by the body’s response to infection, leading to tissue damage, organ failure, or death if untreated.
77
What is the Sepsis 6 management bundle?
**3 out:** 1. Measure lactate via venous blood gas 2. Take blood cultures and regular bloods (U&Es, FBC, CRP) 3. Monitor urine output **3 in:** 4. Give IV antibiotics (empirical) 5. Administer IV fluids (250–500ml Hartmann’s) 6. Provide oxygen if saturation is <94%
78
When do you treat for sepsis based on NICE criteria?
Treat immediately if any high-risk criteria are met. If two or more moderate-risk criteria are present, check lactate and kidney function to decide.
79
Why is lactate measurement important in sepsis?
It indicates tissue hypoperfusion and severity. High lactate suggests more severe sepsis and guides urgency of treatment.
80
What are signs of acute kidney injury (AKI) in sepsis?
- Reduced urine output - Elevated creatinine levels - U&E abnormalities

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