It is important to reflect when something goes wrong to prevent it happening again in the future. Sue N’Jie, dentolegal adviser at the Dental Defence Union (DDU), explains how to respond to an adverse incident.
Everybody makes mistakes. Despite the best intentions of the dental team it is inevitable that sometimes mistakes will happen in the dental practice.
When someone makes a mistake, it is imperative that the response is appropriate.
A suitable response will result in those affected feeling properly supported. And there are opportunities to learn and improve.
By contrast, trying to cover-up errors or cast blame on individuals is likely to inflame the situation and fuel mistrust.
What is an adverse incident?
An adverse incident is any event that causes, or has the potential to cause, harm to patients, other members of the dental team or members of the public. Examples include:
- Clinical issues. Such as the accidental extrusion of sodium hypochlorite during root canal procedure, wrong tooth extraction or bur injury
- System failure. Such as poor IT security leading to the loss of sensitive patient data
- Administrative lapses. Such as failing to send an urgent referral for a patient with a suspicious lesion.
It is important that staff feel comfortable and receive training to identify adverse incidents when they occur.
There should be a clear process for raising concerns to a senior nominated individual. Such as a line manager or the practice manager as outlined in Standard 8.4 of the GDC’s Standards for the Dental Team.
When something goes wrong
In its guidance on the professional duty of candour, the GDC states that it is important for dental professionals ‘to be open and honest with patients when something goes wrong with their treatment or care.’
The GDC states that when something goes wrong you must:
- Tell the patient, in a way they can understand and answer any questions
- Offer an appropriate remedy or support to put matters right (if possible)
- Explain the short- and long-term effects of what has happened.
Sometimes, dental professionals believe that apologising is an admission of legal liability. Something an individual could use against you in the event of a claim. This is not the case.
Although it is important to apologise, it can sometimes feel daunting. Below are some tips for a successful apology:
- Start by explaining what has happened. Once there is context, an apology can naturally follow. Don’t speculate on reasons for what happened; just explain if it requires further investigation
- Speak as you would in a natural conversation, in the first person. ‘I am very sorry that this happened’ sounds more sincere and less defensive than: ‘The practice regrets…’
- Think about body language. Saying the right words while standing over the patient with arms folded may not seem like an apology at all
- Take your time and ensure there are no interruptions
- Think of a meaningful apology as part of a process of restoring trust. Be receptive to the patient’s wishes
- You may decide to make a goodwill gesture in the circumstances. But this is not a substitute for a proper apology.
The apology should come from the most appropriate member of the dental team. You should record this in the patient’s records.
Duty of candour
All practices should have procedures in place that support adverse incident reporting by staff and let the practice meet its obligations as a registered organisation.
In Scotland, this internal clinical governance process should align with the practice’s statutory duty of candour.
This legal obligation is distinct from the ethical duty of individual dental professionals. It applies to healthcare organisations, including dental practices and NHS trusts.
The details are set out in the Health (Tobacco, Nicotine and Care etc) (Scotland) Act 2016 and the Duty of Candour Procedure (Scotland) Regulations 2018.
The statutory duty of candour sets out what dental practices must do when something unintended or unexpected has occurred in the care of a patient and has resulted in:
- Their death, where this relates to the incident and is not simply due to the natural progression of the illness or condition
- Impairment (of sensory, motor or intellectual function) that lasts or is likely to last for 28 days continuously
- Changes to the structure of the body (for example, erroneous extraction)
- Prolonged pain or prolonged psychological harm – this must be, or likely to be, experienced continuously for 28 days or more
- Shortening of their life expectancy
- Where the patient requires treatment by a healthcare professional in order to prevent death, or the adverse outcomes above.
The dental practice’s representative must tell the patient about it in person as soon as is reasonably practicable after a notifiable incident occurs.
The practice is required to provide a full explanation of what is known at the time as well as an apology.
Taking steps to limit risks
Additionally, dental practices should notify healthcare regulators following an adverse incident.
In Scotland, The Healthcare Improvement Scotland (Applications and Registrations) Regulations 2011 requires practices to notify Healthcare Improvement Scotland (HIS) of significant incidents and accidents. HIS has produced guidance, which includes a list of notifications and timescales.
We can never eliminate the possibility of an adverse incident entirely. But practices can reduce the risk by taking steps to identify and address all significant threats to patient safety.
If you have any concerns, contact your dental defence organisation for further advice.