Clinical Governance Summary

Many of you will have received the news that you have or have not been given the opportunity for a DCT interview in the coming weeks.

For those that have- well done and make sure to come along to our zoom event tomorrow (details below).

For those that have not got an interview and are now unsure about how to go about getting an interview for general dental practice send me an email: william@dentalsjt.com

On to the topic to discuss today- Clinical Governance

Many of you by now will have been introduced to clinical governance through your DFT or previous DCT experience, so this is to give you a quick overview incase you need to discuss it during an interview. 

Quick question: what is the difference between Audit and Research?

Answer: Audit checks the standard, research sets the standard. So, an audit would confirm if you get all the words correct when singing your favourite Taylor Swift song. Research would determine which Taylor Swift album (old vs new) is better.

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The thing that many people going to the interview don't realise is..... that there will only be 1 or 2 marks for actually coming out with a definition. The majority of the marks will be for relating what you know to what ever scenario they give you to discuss. 

So I am going to give you a scenario, and walk you through how I would answer it.

Scenario:

You see a patient as a toothache appointment who normally sees a different dentist in your practice or department but they called in sick today. The patient tells you they had a filling last week, but you can not find any written notes on the computer system. You see in the appointment history the patient did attend for a filling. 

Discuss how you would manage this situation and what are the clinical governance issues involved?


Answer:

I would manage this situation in 2 phases

  1. Immediate- patient in the chair:

I would explain to the patient I am unable to access any notes from the previous appointment, apologise for this and then assess and manage the toothache as appropriate. A recent filling which is causing more problems could indicate periapical periodontitis associated with a necrotic pulp and the patient may require a Root Canal treatment or an extraction, but I would undertake a thorough history of the symptoms and a clinical examination, ultimately explaining everything to the patient and letting them consent to any treatment they would like done today. An option is no further treatment but another appointment with the other dentist, however there could be risks involved with doing no immediate treatment which should be explained to the patient also. 

    2. Following the toothache appointment:

I would then consider all of the clinical governance issues involved. As we know clinical governance can is a framework to ensure that healthcare professionals are consistently delivering high quality treatment and seeking to continuously improve it.

The pillars of clinical governance are:

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Pillars of clinical governance in general dental practice

Specifically for this situation I would make contemporaneous notes of all of my treatment.

I would then discuss with the dentist who normally treats the patient, informing them I was unable to access their notes. Perhaps the computer wasn't working that day or there was another reason the notes were not recorded in the patients e-record.

Information and IT

I would ensure that all the staff are trained appropriately to use the computer software. I would also ask the lead for data protection if the records are appropriately backed-up

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Risk Management

I would explain to the other dentist that records are vital to reduce risks for patients and staff. Through reviewing notes we can also learning from previous mistakes, which can help to improve the quality of care patients receive.

Audit

I would suggest that the dentist undertakes an audit to make sure all of their notes are correctly and contemporaneously recorded. They could use guidelines from the FGDP, I could support them by doing an audit at the same time of my own notes.

The 5 steps of the audit cycle are:

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Audit cycle

Education and Training

Ensure all members of staff are trained on recording keeping. This is included in the GDC standards of the dental team document, so it really is a team effort. If anyone feels they need more training, and it should be recorded in their PDP and a CPD event should be scheduled ASAP

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(if I was doing well for time I would add this in)

I can talk you through the audit cycle in more detail if you would like?

THE AUDIT CYCLE

1 The standard All patients’ records must:

  • Have clear identifying details.
  • Be legible.
  • Be dated and filed chronologically.
  • Have clinician’s signature with his/her printed name and designation.
  • Have clear history, diagnosis and treatment plan for the patient.
  • Only use approved abbreviations.
  • Have cancellation and failure to attend recorded.
  • Retain the original record if any alterations are made.

2 Assess local practice

The indicators

  • % of records meeting the above standards.

Data items to be collected

  • Number of records which are clear and legible recorded on a pro forma.

Suggested number

  • 20 clinical records per clinician are assessed.

3 Compare findings with standard

4 Change

  • Identify clinicians whose record keeping is consistently below standard and advise improvement. Consider digital input to have a printed record.

5 Re-audit

Resources required Data collection:

  • Assess and grade clinical record on pro forma.
  • Assistance required: Data collection and analysis by Clinical Audit Dept.

End of scenario

Remember- this will be a timed and stressful situation, so do not panic. 

In order to stay calm at the start you could have a "safe" phrase to say so that you are calm when you start and hopefully "tick a box" to make sure you mention patient safety. In all of my interview situations, I usually start with "patient safety is utmost in the dentists mind at all times". 

I would also be smile, try to maintain eye contact with the camera and say thanks to your examiners.

I hope you found this useful.

 

Have a good week! 
Will

 

 


References:

Scally G, Donaldson LJ. 1998. Clinical governance and the drive for quality improvement in the new NHS in England. BMJ 317(7150):61-5


If you are applying to DCT this year and have a virtual interview soon.... Make sure you don't miss our next FREE ZOOM event this week!

Our Free DCT Interview Revision Zoom event on Wednesday 14th April at 7:30 pm.

The meeting will cover: 

  • Topics to revise for the DCT virtual interview
  • How to build a portfolio for dental specialty training
  • Q+A- bring along any interview questions and I will try to answer them!

Register in advance for this meeting:
 https://zoom.us/meeting/register/tJAlf-yorT4sGtz3BH8NRwUAN_wAeuHt0tO4

After registering, you will receive a confirmation email containing information about joining the meeting.

If you have any questions you would like answered during the event, please contact us on william@dentalsjt.com

PS. The person who asks the best question either via email or on the night will win an awesome prize from Colgate, who are also kindly giving everyone who comes along to this free zoom event some free samples to give to patients or your friends! 


Spaces filling up fast as usual for the zoom, and only the first 100 attendees will be able to join on Wednesday so remember to log in on time!

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