Dr Eamon Croke’s advice to dentists about the audit tools for general dental practitioners in the Best Practice section of the Association’s website is clear: “Get involved with them. Use them now. Don’t wait for the sheriff to ride into town”. And the sheriff is coming in the form of the new Dental Act. Nobody knows exactly what will be in the Act, but the Madden Report (the Report of the Commission on Patient Safety and Quality Assurance, 2008) and legislation for other healthcare professions gave pretty good indicators that dentists can expect to see practice licensing and practice inspections.
It was following the publication of the Madden Report that the Association established the Quality and Patient Safety Committee to provide advice that is practical, reasonable and based on best evidence. Eamon was appointed to chair the Committee and he says: “Dentists are good at dentistry. We know the standard of dentistry is high in Ireland, but it can be difficult to keep on top of all the guidelines for dental practices. Our remit is to provide advice that is usable in a standard dental practice and which can generally be implemented without a huge amount of money, time or staff.”
Easy to use
To date the Committee has produced advice on decontamination; hand hygiene; emergency drugs and equipment; amalgam separators and waste management; complaints procedures; sharps injuries; and, risk assessments and safety statements. The structure of the advice is based on the legal and ethical requirements for dentists in the area being examined. It comes at three levels: the essential requirements; the recommended actions; and, future proofing. Eamon states: “Every piece of advice we give comes with an audit tool, which allows any dentist to self-assess his or her own practice without anyone looking over their shoulder. It allows them to carry out a risk assessment and then to implement good risk management. Remember, we don’t create these regulations: what we are doing is bringing them into an easy-to-use format for our colleagues – the general dental practitioners.”
Eamon believes that all dentists should prepare for the forthcoming Dental Act. He points to the extensive inspection regime that has been imposed on pharmacists and says it is not unreasonable for dentists to speculate that such an inspection regime might apply to them in the relatively near future. “As an Association, we have a responsibility to prepare our members for that. We don’t know exactly what will be in the new Act, but we do know that since the Madden Report, HIQA has been recommended to undertake the process of licensing and inspecting all healthcare facilities.”
One of the areas that can cause dentists blood pressure to rise is the issue of complaints – and handling complaints. “The reality here is the opposite of what some dentists may have expected. Since 2012, dentists have been obliged to have a complaints procedure in place and on display. There has not been a dramatic increase in the number of complaints received generally about dentists and Dental Protection has stated that there has been a leveling off in cases being taken against dentists.” Dr Croke says that putting a complaints procedure in place in a practice generally has the effect of reassuring patients – rather than instigating complaints as some dentists feared.
Separating the good from the bad
Within the area of waste management, the issue of amalgam separators is clear to the Quality and Patient Safety Committee. While it is not a legal requirement to have an amalgam separator, the Association recommends its members to have proper waste disposal and amalgam separation procedures in place. Eamon says: “Dentists are obliged not to dispose of amalgam waste through the water system, so they must have an amalgam separator. This is a great opportunity for Irish dentists to show leadership on an environmentally sensitive issue.”
A good lesson
The experience in recent years of the clinical audit of radiology in dental surgeries has, Eamon believes, provided a very good lesson for all the participants. “The first round was a failure. The second round was a success because the Association was involved. It was able to help with the development of the process for the audit; and it was then able to inform and train dentists in advance of the audits. This led to an unprecedented outcome. The Association’s involvement was the key factor. It calmed and reassured dentists. It is a very important lesson for future audits and inspections. Dentists have to be informed and trained and the involvement of the Association is a critical ingredient for success.”
And that’s one of key drivers of the work of the Quality and Patient Safety Committee – the knowledge that change is coming in the shape of new legislation and if it is to be successful, the Association has to be involved. By providing this level of guidance and leadership now, dentists have a chance to be as prepared as possible and therefore to reduce the challenges of the coming changes. “We need clear programmes to train and inform dentists. The Association is doing the groundwork in advance of the changes likely to come in with the new Act.”
He goes on to say to members: “I hope that members will see the benefit of the work of the Quality and Patient Safety Committee and of tackling audits now, in their own time – not after legislation arrives.
The radiology audit proved that collectively, we can do these processes well. It would be naïve to think that there won’t be difficulties with the new legislation. Dentists need to plan now while there is still time to do it at a reasonable pace.”
Eamon says: “Our work gives every member the chance to be in control and gives them the ability to deal with new developments. So I implore all general practitioners: get involved now and don’t wait for the sheriff to ride into town”
No hurler on the ditch
Eamon Croke advises dentists to get involved with the best practice advice from the Association. It’s advice he follows through his own involvement in the Association, not to mention his Presidency of the Dental Council. Born in Rhodesia, brought up in Clare, secondary school and university educated in Dublin, he worked in the UK from graduation in 1979 to 1992 when he completed a Masters in Prosthetic Dentistry at the Eastman.
A father to a happy band of young adults and grandfather to Mia, he enjoys sports, cooking and especially hill walking. A quirk of his early years is that he follows Munster in the rugby, Cork in the hurling, and Kerry in the football – despite the fact that his Ballyboden St Enda’s club captain was the Dublin full back, Sean Doherty. Interestingly, one of the reasons he returned to Ireland from the UK was that he felt – strongly – that the Leaving Certificate is a better process to go through than A Levels in the UK.