Running head: Patient Safety and Risk Management in Dental Practice: Are There Enough
Guidelines? An Evaluative Study on The Existing System in a Dental College of Riyadh 1
Patient Safety and Risk Management in Dental Practice: Are There Enough Guidelines? An
Evaluative Study on The Existing System in a Dental College of Riyadh
Introduction
While it is essential to the practice of healthcare professionals to concern about patient
safety, it is relatively current that it has been transformed into a specific body of knowledge and
therefore patient safety may be considered as a relatively ‘innovative’ discipline. Its core ideas
are to prevent the occurrence of avoidable adverse events (errors, complications and accidents)
accompanying the practice of healthcare and to reduce the impact of unavoidable adverse events.
This is a simple definition for the multifaceted, complexed nature and many key elements in the
practice of patient safety. There are economic, financial, social, cultural and organizational
matters of a patient safety environment that makes it unpractical to simply define it as the
practicing safe health care or protecting patients from harm by health care professionals. It is
essential for all health care professionals and health care organizations to become more
acquainted with the overall framework of patient safety, to dynamically contribute in hard work
to apply patient safety procedures in everyday practice and to create a culture of patient safety
culture (Yamalik & Perea Pérez, 2012).
There is a constant concern and interest in dentistry for matters related to patients and
practicing safe and quality care in the everyday dental practice. Yet, like other health
professions, more attention is given to patient related matters and safety-related matters
(Yamalik & Dijk, 2013).
Furthermore, there is an emerging professional consideration of risk management, patient
safety and handling errors. Rather than hiding them, errors are now understood as learning
material and by that, the number of publications on dental errors are increasing. As an example,
Patient Safety and Risk Management in Dental Practice: Are There Enough Guidelines? An
Evaluative Study on The Existing System in a Dental College of Riyadh 2
prescribing errors in dental practice is a potential ground for development in the medication
management process and patient safety (Yamalik & Dijk, 2013).
An empirical data on the attitudes of dental professionals and dental auxiliaries about the
reporting of medical errors was collected in Riyadh, Saudi Arabia by Al-Nomay et al., (2017),
most respondents (94.4% of them) expressed that medical errors should be reported. Yet, insights
of the norm, personal preferences and existing practices regarding which type of error should be
reported were inconsistent. Only 17.9% of respondents perceived that reporting errors that results
in major harm is the present practice. More than 68% of the participants disclosed a personal
belief, a perception of the norm and a present practice that errors must be reported by the erring
dentist. Respondents at government establishments were more likely to report errors than those at
private establishments (Al-Nomay et al., 2017).
The Problem
Dentists are now practicing more surgical procedures in their dental setting, the
possibility of experiencing litigation from malpractice has significantly increased. Having good
skills and techniques are not sufficient enough; dental professionals must dynamically and
thoroughly adhere to strategies of reducing risk to support the minimizing or eliminating harm
and lawsuits. The dentist can avoid possible harm and lawsuits by devoting better attention to
detail, by adhering to good practice, and managing patients’ expectations and outcomes in an
improved matter (Dym, 2012).
Dental professionals are at risk of being exposed to severe implications on health from
occupational exposure to infections. It has been previously acknowledged in several areas and
researches the matters of compliance with risk management procedures, the effects of which can
be reduced by technical developments, employment of guidelines in best practice and by
Patient Safety and Risk Management in Dental Practice: Are There Enough Guidelines? An
Evaluative Study on The Existing System in a Dental College of Riyadh 3
regularly emphasizing policies of infection control locally with training and awareness
campaigns (Westall & Dickinson, 2017).
A study done by Alhamad et al., (2015) in the Eastern Province of Kingdom of Saudi
Arabia reporting the prevalence of medical emergencies in dental clinics and self‑perceived
competence of dentists. Over 60% of the participants have encountered medical emergencies at
least once. The most common medical emergency experienced by the dentists is vasovagal
syncope by 53.1%, hypoglycemia 44.8% and foreign body aspiration was reported by only 5.5%.
Over 74.3% of the respondents stated that they are supplied with emergency kits in their clinics.
Around 33% of the dentists in the study were either lacking confidence or lack the knowledge to
use emergency drugs (Alhamad et al., 2015).
Reducing the risk for medication error by improving dental prescriptions quality and to
encourage the rational use of prescriptions, and patient safety. One study reported that dental
extractions are shown to be related with a low but substantial postoperative risk of sepsis,
particularly in senior patients and those with chronic systemic diseases. In an investigation
regarding errors of radiographs with undergraduate students, it was observed that 64.06% of the
images were acceptable, and 35.94% of the images were unacceptable. Accordingly, it was
proposed that good training and knowledge of the distribution of anatomical region and the types
of error can help prevent these errors and retaking of the radiographic images. Reporting and
examining errors could significantly benefit in identifying the core contributing factors (Yamalik
& Dijk, 2013).
Purpose of the Study
According to the mentioned literature, knowing and analyzing the factors that cause
errors is critical in order to initiate changes which will prevent the errors. It also critical to
Patient Safety and Risk Management in Dental Practice: Are There Enough Guidelines? An
Evaluative Study on The Existing System in a Dental College of Riyadh 4
understand that single errors or events are usually the outcome of the convergence of several
contributing factors. For that, preventing errors necessitates a systemic approach to change the
conditions that lead to these errors (Yamalik & Dijk, 2013).
Like all healthcare professionals, it is also expected from dental professionals to have an
improved knowledge, awareness and concern when it comes to patient safety and risk
management, and that it is practiced in the daily dental care delivery. Though, patient safety is
more widely recognized in healthcare organizations all over the world, numerous health
professionals still do not effectively practice it. Moreover, healthcare students are not widely
taught regarding the practice of patient safety and risk management (Yamalik & Dijk, 2013).
Significance of The Study
The aims of this study are:
1. To improve awareness of the significant risk of errors during the delivery of dental care
among dental professionals.
2. To provide data on the working practices and clinical environment of dental clinics and how
they prevent errors from happening in the first place,
3. To focus on the problems with compliance to risk management procedures in dental clinics,
4. To recognize and recommend possible methods and practices to prevent occupational errors,
5. To recommend future studies to investigate the compliance with risk management system
between dental professionals by studying their perspective.
Research Question
To analyze the perspectives of dental professionals on the current practices of risk
management and patient safety guidelines in order to prevent dental practice errors from
Patient Safety and Risk Management in Dental Practice: Are There Enough Guidelines? An
Evaluative Study on The Existing System in a Dental College of Riyadh 5
happening. Evaluate the current guidelines applied in dental facilities and assess its efficacy and
effectiveness in patient safety and risk management.
Methodology
The included population number in the government dental college in Riyadh, Saudi
Arabia from faculty, clinicians, interns and fourth and fifth year students are a total of 152. A
self‑administered questionnaire to110 randomly selected from the included population to achieve
a confidence rate of 95% and a margin error of 5%. The questionnaire is prepared and modified
under the supervision of an experienced faculty member.
The questionnaire has been pilot tested on a sample of 15 licensed dental professionals
practicing in government and private clinics in Riyadh to test participants’ understanding of the
questions and prevent errors in its administration. The pilot study was tested for validity using
Cronbach’s alpha validity test with a .9376 reliability score. The study objectives will be
described prior to the questionnaire for the respondents to comprehend and give an informed
consent. Licensed dental physicians, dental hygienist and dental students in the fourth year and
above are included in this study. Dental students who have less than a year of dental care
experience and dental assistants will be excluded from this study.
The questionnaire will consist of six sections, first section will cover questions on
demographics: The number of years in dental practice, dental qualification and the field of
experience in dental practice (private, government or both), and the academic qualifications of
the dental professional. The second sections will cover questions on the participants general
knowledge in risk management and patient safety (Yamalik & Dijk, 2013). Section three will list
errors associated with clinical documents, information and referral of patients in the dental clinic,
questions will ask if there are risk management and patient safety guidelines to prevent those
Patient Safety and Risk Management in Dental Practice: Are There Enough Guidelines? An
Evaluative Study on The Existing System in a Dental College of Riyadh 6
errors from happening. Section four will list pharmacological prescribing errors, questions will
ask if there are risk management and patient safety guidelines to prevent those errors from
happening and the source of the guidelines. Section five will list errors from surgical events,
questions will ask if there are risk management and patient safety guidelines to prevent those
errors from happening and the source of the guidelines. Section six will list probable accidents
(random events, unpredicted and unanticipated injury or harm to the patient) in dental practice,
questions will ask if there are risk management and patient safety guidelines to prevent those
errors from happening and the source of the guidelines (Yamalik & Perea Pérez, 2012).
Statistical Software Package SPSS will be used to perform statistical analyses. Frequencies and
proportions of diverse responses will be measured for categorical variables.
Results
Appropriate statistical methods and tests will be used for analysis of the results.
Discussion
The results obtained will be discussed considering the available local and international
studies and review.
Conclusion and Recommendations
The conclusion and recommendations will be derived from the results and discussion.
Patient Safety and Risk Management in Dental Practice: Are There Enough Guidelines? An
Evaluative Study on The Existing System in a Dental College of Riyadh 7
References
AlBaker, A. A., Al-Ruthia, Y. S. H., AlShehri, M., & Alshuwairikh, S. (2017). The
characteristics and distribution of dentist workforce in Saudi Arabia: A descriptive cross-
sectional study. Saudi Pharmaceutical Journal, 25(8), 1208-1216.
Alhamad, M., Alnahwi, T., Alshayeb, H., Alzayer, A., Aldawood, O., Almarzouq, A., & Nazir,
M. A. (2015). Medical emergencies encountered in dental clinics: A study from the
Eastern Province of Saudi Arabia. Journal of family & community medicine, 22(3), 175.
Al-Nomay, N. S., Ashi, A., Al-Hargan, A., Alshalhoub, A., & Masuadi, E. (2017). Attitudes of
dental professional staff and auxiliaries in Riyadh, Saudi Arabia, toward disclosure of
medical errors. The Saudi dental journal, 29(2), 59-65.
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Westall, J. O., & Dickinson, C. (2017). Compliance with occupational exposure risk
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journal, 63(6), 291-297.
Yamalik, N., & Perea Pérez, B. (2012). Patient safety and dentistry: what do we need to know?
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