The keeping of records is a particularly cumbersome yet vital aspect, and the equipment used for decontamination and sterilisation lies at the heart of ensuring compliance.
HTM 01-05 2.4n states: “Equipment used to decontaminate dental instruments should be fit for purpose and validated. This means that the device should be commissioned, maintained and periodically tested by a Competent Person (Decontamination) or service engineer, that records of maintenance should be kept and that correct functioning should be monitored and recorded”.
Therefore all testing reports are required to be kept for documentary evidence of the effectiveness of equipment in the dental practice. However, the meticulous task of record keeping can be time consuming and also has the potential for inaccurate logging of data due to inevitable human error. It is therefore crucial to try to find a way to enhance the efficiency of your record keeping and streamline this process, whilst maintaining the quality of data.
One area that can be especially time consuming is the recording of daily and weekly test cycle data of your autoclave and/or washer disinfector. From the everyday ACT tests completed each morning to measure the time, steam and temperature of the autoclave, to the weekly residual air and air leakage tests, each check requires detailed annotation, documented in a daily logbook for every piece of equipment in the practice.
Although absolutely essential in terms of practice inspections, manually having to record this data and then store it can often be seen as more than a mere inconvenience. Some autoclaves will have a printer installed, which will print off a receipt that should be kept, which makes the process a little easier and more efficient, but it still requires time and effort to collate these print-offs, not to mention the physical space needed to store the data.
However, there are new technological solutions that can make all of this a thing of the past. The latest autoclaves from Eschmann are compatible with computer software that can capture all of the data necessary from your tests and automatically save it onto your PC. This means you have no forms to fill in and store, and you don't have to transfer data using memory cards or USB devices.
With such software you will benefit from quick and easy cycle sign-off at the click of a button and you could even monitor the progress of your cycle from your PC or laptop. The latest software will also show you when your instruments are ready for use, as the software operates in real-time meaning it is always up to the minute, which is precisely what you need in a busy dental practice.
The Eschmann real-time Wireless Cycle Logger with automatic daily/weekly test cycle software is compatible with the company's own autoclaves and washer disinfectors. Providing automatic population of daily and weekly test cycle records, this software is making manual record keeping and storage a thing of the past, while also providing added security through accurately recorded and validated cycles and tests ready for official inspection.
To take away any unnecessary worry in the lead up to your next CQC inspection, make sure you have everything in place now.
For more information please visit www.eschmann.co.uk, or call 01903 753322
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See what others say:
I just wanted to write to let you know how your package is working for us in our practice.
I’m not sure you are aware but we relocated premises in August 2014 moving from one surgery to three surgeries. We recruited new staff and increased from five to sixteen, which included a trainee nurse, a nurse who had not worked in general practice for a year or so, an apprentice and a new housekeeper who had not worked in a dental practice. It did feel like I was running around in circles as I did naively think you just transfer from one site to another.
I then came across the RightPath4 CQC package and purchased it at the start of the year and what an enormous benefit it has been to our practice.
Having read all the information I delegated everything to all the staff, we then come together during lunch times, staff meetings etc to discuss, plan, and modify. All the staff have completed the poisoned chalice, which is an interactive series of questions regarding each room. I can then review their answers and add any questions they were unsure of or did not know, to the agenda for our next staff meeting. It has led to interesting staff meetings, with debates and staff keen to demonstrate what they do and what we should do.
The virtual inspection and clinical governance have been areas that the assistant manager and myself as practice manager have completed, and what a huge help they have been. They look at: how we work in the practice, who should be doing it, why we should be doing it, when it should be completed, how it is completed and what we need to complete. We have looked at every aspect at what we do, again, working closely with all the staff, who have helped by giving their input on the paperwork, processes and procedures we need to complete. We have even kept all our working documents as evidence of how we have moved on.
From my point of view it’s all very well, writing a policy and procedure but does it really work in practice, I found that by getting all the staff involved, helps with morale and motivates them more to know they are being heard, and that their input is valuable and taken very seriously.
I know the package is something which we will use continually, to review and monitor our practice, and any questions I might have, I know I can email you.
Sorry for going on I just wanted to let you know how grateful we are for your package and the help you have given and continue to give to us.
Noah’s Ark Dental Practice
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You’ve got CQC hindsight, but have you seen what’s coming?
The CQC have ‘Fresh Start’ plans for us in 2015
It’s part of their strategy for 2013-2016, Raising standards, putting people first).
They are more focused than the previous ones and inspectors will be more
experienced in assessing dental practices.
The new standards are divided into eleven Fundamental parts.
Fit and Proper Person (Directors) and Duty of Candour are 2 new standards.
The CQC have also beefed up their enforcement powers, meaning that they
may not give you a warning before they prosecute.
How do the old ‘Outcomes’ relate to the new Standards?
The simplest way to explain this is for you to complete my CQC survey: https://www.gdpuk.com/index.php?option=com_rsform&formId=57 and then I will send you an explanation of how to relate the old CQC to the new CQC and the new (ish) GDC principles. I will also send you an explanation of what the ‘Key Lines Of Enquiry’ (KLOE) is all about and how it will be applied in April 2015.
What effect have the CQC had so far?
Many of you kindly told me about your CQC thoughts in my survey, (see link above) which is still running. By sending it back to me, you will now know what or who KLOE is. The CQC inspector will use these KLOE’s to guide the inspection process and make a judgement. The CQC still haven’t decided about publishing these.
I have summarised what you have told me so far from my surveys and will be discussing them with the CQC. We may yet be able to have a sensible regulator looking at the right things in an intelligent way.
My prediction for 2015 is that FEES, Cosmetic dentistry and dermal fillers will also come under the spotlight.
Brief analysis (from 76 surveys)
I have used this as a pilot survey to determine whether there is a need to gather more information on how well the CQC registration and inspection process is received and what the beneficial effects may have been in driving improvement.
I think relatively few will have experienced re-registration and therefore a low %age answering YES to Q1 may be expected. However it is disappointing to see that 48% still felt that the process has not been made clearer.
There continues to be much confusion over legal entities and I know (from personal experiences of clients that this is still a problem now, 76% of respondents agree.
81% felt that the inspection was not structured to reflect dental practices; even higher (87%) saying that the nuances were not understood and many said that a dental adviser is required.
It seems that few felt that they understood what the CQC expectations are regarding safe, well-led and managed practices. I was particularly pleased that our own clients were in general more ‘upbeat’ about the potential benefits of CQC compliance and also felt more empowered and knowledgeable (judging from some open question comments).
The open questions were designed to test whether the process of declaring ‘compliant’ 48 times in the original application had sparked an interest in them to get things done before inspection, just in case. It seems that this was the case in as much as 72% said they had done some things, although I need to look more closely at this figure because some of what was said was fairly minor ‘window dressing’ was one comment.
The most significant results I feel were relating to the perceived benefit of CQC registration and inspection.
The positive improvements noted by patients and staff reached only 14% and the consequential improvements to the business reached 21%. Finally regarding your additional thoughts, there were many suggestions and yet only 6.5% of these were positive. I have concluded that an improved and much larger survey spread amongst a wider audience is required.
OK, so what?
From April 2015, CQC inspection reports will look quite different. Instead of considering just 4 or 5 Outcomes; the inspection will be constructed in a different way to test whether your practice clearly demonstrates that it is safe, caring, responsive, effective and well-led? A CQC inspector has described how the new process enables them to ‘get under the skin’ of the practice and see what is really happening.
Safety is now considered of paramount importance following on from the terrible instances of poor care graphically illustrated in the past few years. Although the CQC had considered that dentistry was relatively much lower risk; there was a severe jolt to this belief recently in Nottingham. The GDC are also convinced that there are also still much greater problems within the Profession. So it is my guess that safety will share top billing with being well-led.
It is hard to imagine that a well-led practice would be unsafe or that there would be many unresolved complaints or that there is a high staff turnover or patients don’t have fees explained properly.
RightPath4 can provide a system of governance mapped to 2015 CQC requirements which is simple to implement and does not cost £thousands or run to thousands of pages. It is easy to bespoke it to your practice and use as an important part of your practice meetings and induction. We have a unique template tool which helps you give confidence to the CQC that your practice is safe, caring, effective, responsive and well-led.
In the next blog article, I’m going to discuss how the CQC are going to assess and inspect in 2015.
Here’s wishing you a Happy, Healthy and Prosperous New Year,
Keith Hayes BDS
Whistleblowing and responsibility
The UK law related to whistleblowing changed significantly at the end of June with the result that legal protection for employees who report wrong-doing by their employer is only now afforded to those raising allegations of public interest. In other words, now the element of “good faith” required previously has been removed, disputes over personal issues, such as pay or performance management which lack a public interest element, will no longer be protected under the legislation.
So perhaps you should ask yourself; should I be blowing a whistle and what is the purpose?
Team members are often the first to realise that there is something amiss within the practice. However, they may not wish to express their concerns as they may feel that speaking up would be disloyal to their colleagues or to the practice.
Whistleblowing should primarily encourage and enable team members to raise serious concerns within the practice rather than overlooking a problem or 'blowing the whistle' to an external body. It is important that every organisation, whether it be a dental practice or even a body such as the Care Quality Commission (CQC) itself recognises their responsibilities and takes them seriously and intelligently.
Raising awareness of serious concerns when you work within an organisation asks a lot of the individual and this is the reason why it is necessary to emphasise that they are protected in law by taking appropriate actions. It should be a clearly stated Policy that the practice recognises that the decision to report a concern can be a difficult one to make. If what you are saying is what you believe to be true, you should have nothing to fear because you will be doing your duty to the practice and the patients alike. Furthermore the practice will not tolerate any harassment or victimisation and will take appropriate action to protect the team member who raised a concern in good faith.
Sometimes circumstances have a habit of being rather more intertwined don’t they?
Whenever there is a problem within a dental practice, whether this relates to patient care directly or working relationships; it is wise to attempt a locally agreed solution. Usually a discussion of the circumstances involving all relevant team members will itself point to the correct solution. However sometimes the problem may be so serious or the reaction of the management so ineffective that as a GDC Professional Registrant you feel compelled to take matters further. Whilst doing this, it is extremely wise to examine one’s own position carefully. A thorough investigation will include all parties. All concerns will be treated in confidence and whilst every effort should be made not to reveal the identity of the team member who raised it; at the appropriate time they may need to come forward as a witness.
So that’s clear is it?
I want to encourage everyone to re-confirm the legitimacy of their intending whistleblowing and to be certain that they have:
· Disclosed the information in good faith.
· Believe it to be substantially true.
· Not acted maliciously or made false allegations.
· Not sought any personal gain.
These points could have a significant bearing if you are shown to have decided to speak to the Press or acted in connection with another practice or organisation which work in competition.
There may have been a number of situations where organisations have been subjected to malicious whistleblowing. I imagine that it’s not a pretty sight and I’m afraid it would have a habit of rebounding badly on the perpetrator as well as the victim. Some of these people may even have found it necessary to leave Dentistry.
The more one thinks about it; the more one can see that whistleblowing can be used in a positive way for the general good, but equally it can be used in a negative malicious way.
One may envisage a situation where a regulatory body has experienced ‘difficulties’ with a Provider and has then approached another regulatory body to re-examine the Provider. This used to be referred to as ‘double jeopardy’, although now it could even be triple jeopardy. You may possibly feel that such things could never happen in this fair Country of ours; I couldn’t possibly comment.
How to raise a concern in your practice
As a first step, anyone with a concern, should raise it either verbally or in writing with the Practice Manager or the Principle if it involves the practice manager.
All concerns must be taken seriously and the team member treated with respect and dignity. The matters involved should then be investigated and the team member advised of what is happening at all times.
Thank you for reading this and whichever of the R’s you feel you may be; Registrant, Regulator or Registrar, I would like to remind you that the use of intelligence, proportionality and responsibility are not your exclusive rights.
RightPath4 is committed to the highest possible standards of openness, probity and accountability. In line with that commitment we look forward to working with all dental practice teams to help them be the best they can be and be justifiably proud of their achievements.
RightPath4 will continue to work on behalf of those in peril on the C, whether that be CQC or GDC and you may be interested in inviting us to visit you. We hope that you will find that you can spend a small amount of money, very wisely!
You could arrange a practice visit from me for as little as £275.00.
Have a look at our website