DOMAIN II: SAFE and EFFECTIVE CLINICAL PRACTICE

Transcription

1 DOMAIN II: SAFE and EFFECTIVE CLINICAL PRACTICE Definitin Dentists are required t ensure that they are capable f prviding apprpriate care fr their patients, whilst als effectively managing and leading the wider team. Descriptin The care that is prvided shuld align t a cntempraneus evidence base wherever pssible, and the quality f care and the management systems that underpin it shuld be regularly audited and imprved. Dental educatrs are als challenged with the task f ensuring that students are cmpetent in basic perative prcedures, and are safe t begin treating patients. This shuld exist as a rbust prcess, acting as a gate-keeper fr access t patient care, and effective mnitring systems shuld als be in place that fllw the student s educatinal jurney, lngitudinally, thrughut the remainder f the prgramme. Current recmmendatins that supprt the benchmarking prcesses fr teaching f pre-clinical perative skills are already available (Field 2015, ASPiH 2017, CEPTS 2016). It is als increasingly cmmn fr schls t emply an electrnic prtfli cmbining clinical activity, perfrmance, and reflective practice in rder t lngitudinally track student prgress (Villalnga et al 2014, Vernazza et al 2011, Kards et al 2009), and this apprach is recmmended. KEY CONCEPTS: Audit and recrd keeping 2.4.1, 2.4.5, Clinical Evidence 2.1.1, Cmmunicatin 2.2.4, 2.3.2, 2.3.3, 2.3.5, , , , , , 2.4.3, 2.4.5, Cntemprary practice 2.1.5, Educatin 2.2.5, 2.3.8, , , 2.4.6, 2.5.1, 2.5.2, Evaluatin 2.1.3, 2.1.4, 2.3.4, 2.3.9, , , 2.4.2, 2.4.4, 2.4.5, 2.4.6, Knwledge 2.1.2, 2.3.6, , Leadership 2.2.4, 2.2.5, 2.3.1, , Managing change 2.2.4, Managing risk 2.2.1, 2.2.2, Raise cncerns 2.2.3, The majr cmpetences in this Dmain are described belw. They include: 2.1 Evidence-based Practice 2.2 Management and Leadership 2.3 Team-wrking and Cmmunicatin 2.4 Audit and Risk Management 2.5 Prfessinal Educatin and Training Each f these elements frms part f a wider strategy t cntinuusly imprve the quality f clinical care and services that are prvided t patients. This wider strategy is ften referred t as clinical gvernance and shuld create an envirnment within which clinical excellence can flurish.

2 MAJOR COMPETENCE: 2.1 EVIDENCE-BASED PRACTICE Whilst it is imprtant fr dentists t be familiar with the scientific principles that underpin their practice, it is equally imprtant t ensure that they are wrking t a rbust and cntempraneus evidence base. This requires a mtivated and interested prfessinal wh is willing t seek ut new infrmatin, ratinalise its surce and credibility, and apply it suitably t the clinical envirnment. Learning utcmes: Demnstrate successful engagement with the scientific basis f dentistry, including the relevant bimedical sciences, the mechanisms f knwledge acquisitin, scientific methd and evaluatin f evidence Apply cntempraneus knwledge f basic bilgical, medical and clinical sciences t all clinical situatins Evaluate the validity f claims made by industry, primarily in relatin t the risk, clinical benefit and cst f prducts and techniques Evaluate published clinical and basic science research and integrate this infrmatin t imprve the ral health f the patient Emphasise current cncepts f preventin, behaviur change, risk assessment and treatment f ral disease MAJOR COMPETENCE: 2.2 MANAGEMENT and LEADERSHIP Effective clinical leadership is increasingly being shwn t result in higher-quality care. Leadership invlves setting a visin fr the team, and inspiring and setting rganisatinal values and strategic gals. Effective management invlves the directin f resurces t effectively achieve thse gals (Swanwick & McKimm 2010). As the leader f a wider-healthcare team, the dentist is respnsible fr implementing a systematic apprach t the delivery f safe, high quality patient-centred, clinical services. This necessarily invlves managing peple and resurces with penness and integrity. On a very basic level this means ensuring that leaders/managers and the team are adhering t all lcal plicies and prcedures. Hwever, upn qualificatin, it is expected that dentists will als be able t deal with minr perfrmance issues, effectively audit lcal perfrmance and mediate necessary changes. Learning Outcmes: Manage and maintain a safe wrking envirnment Effectively integrate ther members f the dental team with regard t risk management, fr example: wrking psture visual perceptin

3 use f equipment dealing with stress crss-infectin cntrl wrking with hazardus chemicals and inising radiatin Effectively raise cncerns in an apprpriate manner, at varius levels Manage adverse events in the shrt and lnger term Cnsider implementing changes within the team and the wider practice envirnment that will significantly imprve efficiency and sustainability f resurces MAJOR COMPETENCE: 2.3 TEAM-WORKING and COMMUNICATION As an autnmus healthcare prfessinal, a graduating dentist is respnsible fr cmmunicating effectively with their patients, the lcal healthcare team, and allied prfessinals wh are invlved with patient-centred care. Being able t cmmunicate and integrate effectively within a team requires a degree f emtinal cmpetence (Flwers et al 2014). It is expected that new graduates will be ready and able t manage their wn patients within a primary care envirnment. This invlves the integratin f bth verbal and written methds f cmmunicatin, judgments relating t time-keeping and awareness f their wn persnal and prfessinal bundaries. Sme f the mst cmmnly-reprted prblems with new graduates relate t their inability t knw when t seek help, and pr timemanagement (Gilmur et al 2014) it is therefre imprtant, n a lngitudinal basis t expse undergraduates t these imprtant elements thrughut the delivery f carefully-planned and realistic clinical duties. Learning utcmes: Effectively lead all members f the dental team Request and share infrmatin and prfessinal knwledge effectively, using verbal, written and electrnic methds Initiate apprpriate referrals t effectively manage care including cncerns regarding abuse and neglect Request and crrectly reprt n clinical labratry and ther diagnstic prcedures and tests Effectively engage with the wider medical team, as required, during rutine and emergency care Effectively explain and discuss aspects f treatment planning t patients including risks, benefits and likely lngevity f treatment interventins

4 2.3.7 Effectively explain t patients the prperties f cmmnly used dental materials, their risks, and intended benefits Educate patients at all stages in their life (including children, adlescents, adults and the elderly (ageing ppulatin)), emphasising current cncepts f preventin, risk assessment and treatment f ral disease Assess and take accunt f the intellectual, sci-emtinal and language develpment f patients Effectively manage patients whse needs, desires and requirements may influence the delivery f rutine dental care Increase the patient s awareness f their wn rle in preventin f ral disease Explain and discuss the need fr advanced prcedures and knw the apprpriate and prper methd f referral fr specialist care Evaluate the results f treatment and establish an effective mnitring and maintenance prgramme, in c-peratin with the wider dental team where apprpriate Manage acute ral infectins, including apprpriate cmmunicatin fr patient referral and prescriptin f drugs Cunsel patients regarding the nature and severity f their diseases and disrders, prviding the patient with realistic ptins and expectatins f hw these are managed Cmmunicate effectively with a labratry technician in rder t design and prescribe apprpriate restratins and appliances Cnduct effective quality cntrl f prstheses (fixed and remvable) and appliances Train allied dental and medical healthcare wrkers in basic skills f ral health prmtin Display apprpriate prfessinal behaviur twards all members f the dental team and in their dealings with ther allied healthcare wrkers MAJOR COMPETENCE: 2.4 AUDIT and RISK MANAGEMENT Risks t patient care can be minimised thrugh effective risk management. This necessarily includes dentists being able t identify when things are ging wrng, why they have happened, and what t d in rder t prevent adverse events frm happening again. Clinical audit is a prcess f measuring and mnitring the quality f care that is prvided against a set standard, r previus perfrmance and this is an essential first step in identifying systematic risks t safe and effective patient-centred care. Learning utcmes: Prduce and maintain an accurate, cntempraneus and secure patient recrd

5 2.4.2 Interpret, grade and audit radigraphic and ther diagnstic images Effectively cmmunicate and manage the hazards within the clinical envirnment including crss-infectin cntrl, use f hazardus materials and wrking with inising radiatin Cnduct quality cntrl f custmised appliances Evaluate the satisfactin/dissatisfactin f thse directly invlved with patient-centred care including, relatives and carers Interpret, implement and disseminate aspects f audit and clinical gvernance MAJOR COMPETENCE: 2.5 PROFESSIONAL EDUCATION and TRAINING It is essential that graduating dentists are familiar with the prcess f cntinuing prfessinal develpment (CPD). Graduatin is cnsidered t be a springbard leading t a perid f lifelng learning, underpinned by this prfessinal and academic develpment, achieved thrugh the acquisitin f quality CPD (DentCPD 2013). Graduates shuld therefre be in the habit f cntinually assessing and updating their knwledge and skills in rder t keep up-t-date with the latest develpments and evidence-based practice. It is als imprtant that dentists are mtivated and interested t learn and develp new skills fr themselves and t facilitate this prcess fr the wider dental team. Learning utcmes: Use cntemprary infrmatin technlgy fr dcumentatin, cntinuing educatin, cmmunicatin, management f infrmatin and applicatins related t health care Assess their persnal knwledge and skill base and seek additinal infrmatin t crrect any perceived limitatins Demnstrate a recrd f achievement, ideally thrugh the use f a cntempraneus prtfli f clinical activity and reflectin; smething t use with pride and t be f value as a learning tl that impacts psitively n their future and cntinuing clinical and prfessinal practice

6 References ASPiH. Simulatin-based Educatin in Healthcare: Standards Framewrk; Available frm: CEPTS. Imprving Safety Thrugh Educatin and Training: a reprt by the Cmmissin n Educatin and Training fr Patient Safety; Available frm: DentCPD. Dental Cntinuing Prfessinal Develpment (CPD) Reference Manual; Eurpean Jurnal f Dental Educatin, Supplement Vl 17. Available frm: Field J. Pre-Clinical Dental Skills Teaching Ntes: Wiley-Blackwell; Available frm: Flwers L. Thmas-Squance R. Brainin-Rdriguez J. Yancey A. Interprfessinal scial and emtinal intelligence skills training: Study findings and key lessns. Jurnal f Interprfessinal Care (2) Gilmur A. Jnes R. Cwpe J. Bullck A. Cmmunicatin and prfessinalism skills f a new graduate: the expectatins and experiences f dental fundatin trainers. Eurpean Jurnal f Dental Educatin Kards R. Ck J. Butsn R. Kards T. The develpment f an eprtfli fr life-lng reflective learning and auditable prfessinal certificatin. Eurpean Jurnal f Dental Educatin (3) Swanwick T. McKimm J. ABC f Clinical Leadership Wiley Blackwell 1 st Editin Vernazza C. Durham J. Ellis J. Teasdale D. Ctterill S. Sctt L. Thmasn M. Drummnd P. Mss J. Intrductin f an e-prtfli in clinical dentistry: Staff and student views. Eurpean Jurnal f Dental Educatin (1) Villalnga R. Pujl R. Mren V. Carratala J. Brrell F. Gudil F. The electrnic prtfli as a teaching cmplement fr technical skills in health sciences. Jurnal f Cases n Infrmatin Technlgy (4) 24-37