#15 – Quality Assurance (Peer Review)

Dentist Peer Review

We want to maintain our reputation for high quality dental care.   The best way to do this is to establish high standards and then work to maintain them.  Although you could take this review process as a personal affront “How could anyone dare to judge my work?”  The spirit of this process should be to allow all of us to demonstrate our abilities to each other.  It’s only human nature that we do our best when we are being evaluated.  It’s the difference between being in a practice and being in the “big game.”  Every client, every procedure should be done as though it were going to be shown at the state Dental Association annual meeting!

The rating system used here is a combination of those used by the California and Pennsylvania Dental Associations.  You should be comfortable with this evaluation process.  By participating, you help set and maintain our high standards for everyone.

Ratings System

Clinical quality review will be assessed each six months.

The following system will be used. The front desk will be asked to search the computer database by code for clients to evaluates specific characteristics. Pull one set of charts for each participating dentist.

Each procedure has a series of characteristics and/or steps that will be evaluated.  Each characteristic/step will be defined on a check list and the lowest rating for any characteristic/step determines the evaluation for the whole procedure.

1 – excellent:  meets or exceeds all standards

2 – acceptable:  okay, no need to re-do, but nothing special

3 – needs repaired or replaced

We  maintain an internal audit procedure for client records as well as a mechanism to assess patient satisfaction. Dr. _____________  is responsible for the Quality Assurance Program.

A.   Record audit

1.         Frequency   Charts are selected for each doctor once every 6 months.  These charts are audited by the dentist who is not the dentist of record of the patient.

2.         Make sure all dentists and hygienists being reviewed are going to be present (no vacation, etc.) full time for the next 10 days to complete their reviews.

3.     Method of selection   All records for audit are selected at random by a secretary.

4.         Audit sheet   please see the next page to indicate the charts needed for the record audit.  All questions are answered by the reviewing doctor based on the findings in the patient record.   The audit sheet is signed by the reviewing doctor then discussed with the doctor of record.

5.         Pediatrics—an extra series of charts

 

B. Secretaries’ Responsibility in Peer Review is to manage the timeliness of this project.  To do this:

1.         Ask the office manager to let the dentists know at doc mtg that its time to pick a week for peer review.  Make sure doctor and hygiene schedules are clear for the next 10 days (no holidays, vacations, continuing education, etc.)

2.         Print the section of this level  for the peer review you are responsible for managing (Dentist, Dentist or Pediatric) Tally sheet saved in –handouts – peer review.

3.         Talk to the dentist to set a 2 day period for one dentist to review charts.

4.         Pull a client’s chart who has had the treatment on the sheet done 1-3 months ago for each doctor.  Put the procedure criteria sheet on top of each chart. Don’t pull a chart with treatment sooner than 1 month ago. Unless the doc didn’t do the procedure sooner. Then take the most recent procedure. Client may still be in treatment and chart will be needed.

(To locate clients with treatment not done frequently (Complete dentures, metal frame partials, implants, root canals, TMJ exam), you can run a report through the office manager.

a)     Click on office manager

b)     Go to Letters, Continuing Care, Misc

c)     Click on any stats option, then edit

d)     Change the procedure to whatever code for which you are searching and change the date range to begin with dates after the last peer review run going through today.

e)     Make sure patients A-Z, nothing checked under status, gender, position or aging balance.  Make sure All Providers and All Billing Types are checked.  Only data fields needed are First Name, Last Name.

f)      Click on okay to save, then click on Create/Merge – Create Data File Only – Copy and paste the list generated and print it out.

g)     You will need to check each patients ledger to determine which doctor did the treatment.

5.         Print the summary page from Excel:  F:levelspeer review recording form.xls – need to print one per dentist. You fill out the: name, date of service, time needed and fee.

6.         Special notes, try to continue multiple procedures for 1 client to reduce number of charts!

Example: A, B, C, and some treatment for 1 client.

7.         If treatment recorded in computer, printout the last 12 months of treatment notes, since dentist will write comments on these sheets.

8.         Stack the charts and sheets for each doctor with the summary sheet on top. Fill out the following information on the summary sheet: Name of DDS who treated this stack of patient charts, name of the DDS who will be reviewing these charts (need one summary page for each dentist to use), the date you will be giving the charts to the reviewing dentist, the deadline date for the charts to be completed and the secretary in charge.

9.         Help in choosing charts:

Complete exam / treatment plans – Only 1 chart, a new client (last 6 months) requiring at least $1500 in treatment

TMJ – any client who has had a splint placed, try to find one placed in the last 6 months

Feedback report- any new client or 5 year review exam that does not have a formal treatment plan

All treatment should have been completed in last 6 months. Paper clip criteria to front of appropriate chart, put all charts with an evaluation recording form on top on docs desk

Then give the charts to the dentist – tell that dentist that you have put the charts on their desk and confirm the deadline for reviewing them.

10.       Charts can be removed from the office overnight for review, but must be returned the next day.

12.       Set the next dentist meeting as the peer review discussion

13.       Check that each dentist is on schedule

14.       When the dentists have finished reviewing their charts and recorded their ratings – the charts and the 2 summary sheets with ratings go back to the secretary.

15.       She will make sure the sheets have been received in a timely manner and arrange a doc meeting when all the docs involved in the peer review process will discuss and agree on all the ratings.

16.       She needs to average each dentist’s ratings and then average the two ratings sheets together – this will end up with one set of numbers. These numbers need to be entered into the dentist that was evaluated spreadsheet (Excel: T: GPdentistsPeer ReviewPeer Review Ratings.xls)) with the month & year.

17.      Two days before this meeting, return each doc his own peer review sheets to evaluate.

18.      When this meeting is over, the docs will return their peer review sheets to the secretary

19.       Return to treating dentist for review 2 days before all doc peer review meeting.

20.       After peer review meeting, print 4 copies of this dentist’s ratings compared to previous years and give these pages to the office manager.  The charts can now be filed.  The rating sheets are not kept once they are recorded in the  spreadsheet.

21.      The dentists will meet one hour early  before their normal meeting time to review the charts and comments from the dentists.

 

For Peer Review – Hygienists and Chairsides

Use the same general approach used for dentists

Special notes – chairside level 3+

  1. Chairsides (beginning in level 3): Pano, CMX, Emergency, PC appointment, sealants
  2. EFDAs will have more procedures than chaisides, to include: amalgams, composit, STM (PC for adults)
  3. Make sure a folder is available for all procedures performed
  4. Make sure all support material available (example – blue sheet for emergencies)
  5. Make sure evaluation form filled out completely

Quality Evaluation Recording Form:  Peer Review recording form

This form includes a worksheet for dentists, hygienists and upper level assistants.

Clinical Privileges Review for Dr. ___________________________    Date__________

1.         State licensure – expires _________________

2.         DEA registration – expires _______________

3.         CPR/ACLS/PALS certification – expires __________

4.         Malpractice insurance in force and date risk management course taken – expires ________

5.         Current physical/mental or chemical dependency that interferes with quality care of client.

6.         Conviction of criminal offense

7.         Any medicare, medicaids sanctions

8.         Limitation of credentials by any organization

9.         Complaints from local, state, or national professional society

10.       Any board certifications

11.       Statement releasing HealthPark from liability attesting to correctness and completeness of information submitted.

______________________________                                                            ____________________

Office Manager                                                                                                      Date

 

A. Management of Emergencies Evaluation Criteria

1.         Blue Sheet

1 – all information filled in, all tests run

2 – some missing client information and tests

3 – Several tests not run or recorded appropriately

 

2.         Intraoral Camera (skip if not needed)

1 – picture taken

2 – picture taken – 1 or more not clear

3 – picture not taken or blurred

 

3.         X-ray

1 – taken if needed

2 – taken, but not clear

3 – not taken

4.         1 – appropriate emergency treatment provided, no extensive treatment begun without a thorough exam and an appropriate financial arrangement

2 – acceptable treatment provided, but other choice more appropriate

3 – inappropriate or too much treatment performed without an appropriate thorough exam

 

5.         1 – narrative of client discussions written out as appropriate – choices, expectations, fees, what client said, as well as what treatment accomplished and the prognosis, did you recommend a thorough exam and / or a prophy?

2 – information present, but sketchy

3 – incomplete information

6.        Medications (skip if not needed)

1 – proper medications prescribed and called in if needed

2– incorrect or no medications prescribed

7.         Post Treatment

1 – “how feeling” call made, client comfortable and noted in treatment sheet- if appropriate

2 – no follow up and client might have had discomfort

 

8.         File Organized

1-   file organized

2-   less than 3 pages misplaced or 3 old IC’s not deleted

3-   more than 3 misplaced or 3 old IC’s not deleted

 

 

B. New Client Exam (same client as “c”) Evaluation Criteria

Medical/ Dental history reviewed with notations and signatures

1-many doctor notes, a sense of who the client is and what they want from us, all medical conditions reviewed in detail.

2-some notes, entire form filled out and signed

3- few notes or signature(s) missing, HIPPA not signed

 

Medical conditions noted

1-medical consult sent where appropriate, chart marked on front and in remarks section if necessary

2-gaps

 

Intraoral Camera

1-all pictures taken-good pictures

2-gaps

 

Exam form (yellow) filled out

1-all sections complete

2-gaps in information

 

Salmon Treatment sheet filled out

1-medical consult sent where appropriate, chart marked on front and in remarks section if necessary

2-gaps

 

Radiographs

1-     complete series for all dentulous clients, all Pa’s show apices and decay x-rays show no proximal overlaps, Panoramic for edentulous clients, all films correctly exposed/developed, not elongated/foreshortened – not more than 2 minor errors

2-     panoramic or all teeth can be evaluated using various portions of various x-rays, although every x-ray is not ideal

3-     some radiographic information not available due to distortion, cone cuts, lack of clarity, etc.

 

Study casts (skip if not appropriate)

1-taken if appropriate, well-trimmed, mounted if appropriate, bubbles removed, wax up completed if appropriate

2-models taken

3-no models

 

File Organized

1-file organized

2-less than 3 pages misplaced or 3 old ICs not deleted

3-more than 3 pages misplaced or 3 old ICs not deleted

 

C. Treatment Plan Evaluation Criteria

1.         Diagnostic aids complete

1 – CMX, panoramic x-rays, study models, blood pressure pulp tests, Intraorals – each arch, problem teeth, portrait, present all necessary information with 1 or less omissions

2.  2-3 pieces of information missing

3 – More than 4 pieces of missing or no diagnostic models, but they are needed.

Health History reviewed

1 – Clients responses written in ink of a different color beside the question

2 – Some written comments

3 – No written comments

 

3.  Green Sheet – information

1 – all examination information transferred to green or salmon sheet and organized appropriately

2 – information present, but hard to follow

3 – incomplete information transfer

4.   Itemized cost

1 – all procedure fees clearly marked in green sheet and computer form

2 – all fees can be found through diligent effort

3 – one or more fees missing

5.  Salmon Sheet – treatment sequence

1 – all appointments outlined in detail

2 – most appointments outlined in detail

3 – not filled out although several appointments required

6.  Client Report (diagnosis, treatment plan)

1 – well organized, clearly written, reflects feelings and goals of client, included:  diagnosis, prognosis, alternatives (if appropriate), risks, results if no treatment

2 – spells out treatment (2 or less minor missions)

3 – incomplete, overly technical and has few references to client feelings or goals, 2 or less minor missions

7.  Financial Arrangement

1 – financial arrangement completed that meets our guidelines

2 –  financial arrangements not signed

3-   poor financial arrangement made

 

8.  File Organized

1-   file organized

2-   less than 3 pages misplaced or 3 old ICs not deleted

3-      more than 3 misplaced or 3 old ICs not deleted

 

D. Endodontics (tx done here in our office by this GP)  Evaluation Criteria

1.         Blue sheet/treatment sheet

1 – all treatment outlined in detail, including emergency appointment documentation of discussion on possibility

of apicoectomy if indicated

2 – gaps

3 – consent form – not signed

 

2.         X-rays

1 – before, during, and post-treatment x-rays clear

2 – all x-rays present, some not ideal

3 – missing or blurred x-rays

 

3.         Intraoral camera picture

1 – taken, shows problem if possible

2 – taken, not clear

3 – not taken

 

4.         Diagnosis

1 – all information clearly organized and appropriate diagnosis written, consent form signed

2 – through the effort the train of thought leading to the diagnosis can be figured out

3 – incomplete information transfer, unorganized treatment plan, inaccurate or incomplete diagnosis

craze lines used to Dx need for crown

 

5.         Economics

1 – all procedure fees clearly marked, release form signed (client, dentist, staff)

2 – all fees can be found through diligent effort

3 – one or more fees missing, release form not signed

6.         Treatment

1 – no perforation of crown or root, conservative access, complete seal to within 1mm of apex,

client comfortable

2 – 1-2 mm from apex

3 – fill more than 2mm from apex, or client  not comfortable at last contact

7.         Medications

1 – all medications prescribed and taken

2 – gaps

8.         Post Treatment

1 – “how feeling” call made, client comfortable and noted in treatment sheet

2 – no follow up contact and client might have had discomfort

 

9.         File Organized

1-   file organized

2-   less than 3 pages misplaced or 3 old ICs not deleted

3-   more than 3 misplaced or 3 old ICs not deleted

 

E. TMJ Evaluation Criteria

1.            Client Questionnaire

1 – completely filled out, many notes by dentist

2 – completely filled out, some notes by dentist

3 – not completely filled out, few notes by dentist

2.            Dentist exam form

1 – filled out in detail

2 – filled out with 2-3 details missing

3 – filled out with more than 2 gaps

3.            Treatment sheet

1 – thorough written description of dentist’s discussion with client including

diagnosis, treatment choices, fees, and possible results

2 – adequate, but not detailed written report

3 – sketchy report

4.            Client Report

1 – filled out completely

2 – filled out with holes

3 – not filled out

5.            Physician referral

1 – filled out and sent to physician or others providing health care to client if needed

2– not sent

6.            Symptoms

1 – completely filled out, many notes by dentist

2 – completely filled out, some notes by dentist

3 – not completely filled out, few notes by dentist

7.            Completion

1 – good diagnosis, client completes treatment, significant improvement,

appropriate referrals (psychological, pain center)

2 – only some improvement

3 – poor diagnosis, little or no improvement, client drops out of treatment

 

8.            How feeling call

1 – made at appropriate time, and if needed

2 – not made

 

9.            File Organized

1-   file organized

2-   less than 3 pages misplaced or 3 old ICs not deleted

3-   more than 3 misplaced or 3 old ICs not deleted

 

F. Crown and Bridge Evaluation Criteria

1.      Treatment Sheet

1 – filled out completely (including diagram, anesthesia, nitrous oxide, treating DDS, etc.)

2 – some materials/comments missing

3 – sketchy entry

2.      Intraoral Camera

1 – before and after picture(s) taken and clear

2 – before and after picture(s) taken but don’t clearly show the area

3 – no or blurred before and after picutre(s) taken

not needed – skip #2

 

3.      Appropriate

1 – more than 50% loss of tooth structure, high occlusal stress, maximum esthetics, failed existing crown, decay

controlled, client older than 16

2 – should have been part of more extensive rehabilitation that was not presented to client

3 – a filling would have been more satisfactory:  cost/benefit analyses

4.         Financial arrangements

1 – made

2 – not made

 

5.         Lab prescription

1 – details completed – type of metal, pontic design, cusp form, etc.

2 – some gaps

3 – lab man designed

 

6.         Lab prescription – esthetics

1 – diagram of shades, picture of tooth with shade tabs

2 – some gaps

3 – no diagram or picture

 

7.         How feeling call

1 – appropriate to call due to number of fillings, depth of filling or difficulty for client

2 – call appropriate but not made

 

8.         File Organized

1-   file organized

2-   less than 3 pages misplaced or 3 old ICs not deleted

3-   more than 3 misplaced or 3 old ICs not deleted

 

G. Complete Denture Evaluation Criteria

1.            Preparation

1 – thorough exam completed, all findings charted, client given written case presentation

2 – attempted to evaluate thoroughly, but one problem was not recognized in advance

3 – either thorough exam, charting, or case presentation omitted

2.            Pictures , Panoramic

1 – before and after  pictures taken, Panoramic x-ray

2 – no before and after  pictures taken

 

3.            Motivation

1 – clients psychological ability to wear dentures evaluated discussed, and documented, reason  for new denture(s) clear

2 –  not documented

4.            Appropriate

1 – reline would not work, existing teeth required extraction

2 – reline would have provided at least 5-10 years of service, teeth could have been saved and client not informed, client can’t wear dentures

5.            Treatment discussion

1 –  written treatment plan (alternatives if appropriate, problems, concerns, cost)

2 – documentation complete, discussion with client documented

3 – no written treatment plan or complete documentation

 

6.            Lab prescription

1 – all details included, whipmix articulator used

2 – all details included, hinge articulator used

3 – lab man expected to make some dentist decisions

 

7.            Lab prescription – esthetics

1 – details esthetics, esthetic try in, teeth mould and set up chosen by dentist

2 – no details on esthetics,

3 – no details on esthetics, no esthetic try in

 

8.            Post Treatment

1 – not more than four adjustments

2 – not more than six adjustments

3 – client not satisfied or five or more adjustments

 

9.            File Organized

1-   file organized

2-   less than 3 pages misplaced or 3 old ICs not deleted

3-     more than 3 misplaced or 3 old ICs not deleted

 H. Removable Partial Dentures (Metal Frame) Evaluation Criteria

1.         Preparation

1 – preliminary models used to design appliance, thorough exam performed before treatment

2 – preliminary design attempted, but not adequate

3 – no preliminary models and/or thorough exam

2.         Appropriate

1 – fixed bridge or implants discussed reasons not used, documented

2 – fixed bridge or implants could have been constructed, but client preferred partial denture

3 –implants or fixed bridges could have been placed, but not presented to the client, poor bone support for remaining teeth, severe uncontrolled decay problem

3.         Treatment discussion

1 – written treatment plan (alternatives, problems, concerns, cost)

2 – documentation complete, discussion with client documented

3 – no or incomplete written treatment plan or complete documentation

 

4.         Financial Arrangements

1 – made, reasonable

2 – not made

5.         Lab prescription – framework

1 – all details included, teeth, diagram

2 – no diagram – lab man design

6.         Lab prescription – esthetics – if anterior teeth replaced

1 – details esthetics, esthetic try in, teeth shade mould chosen by dentist

2 – no details esthetics

3 – no details or esthetics, No esthetic try in

7.         Occlusion

1 – Free end saddles constructed on semi-adjustable articulator

2 – Barn door articulator used inappropriately

 

8.         File Organized

1-   file organized

2-   less than 3 pages misplaced or 3 old ICs not deleted

3-      more than 3 misplaced or 3 old ICs not deleted

 I. Amalgam Filling Evaluation Criteria

1. Appropriate diagnosis and treatment

1 – no other material would have been more appropriate – high decay rate, non esthetic area sufficient tooth support,  very young/old client, current x-ray history shows decay progression through enamel,

Diagnodent reading over 35 for occlusals: treatment appropriate with documentation

2 – amalgam was a compromise that the client maybe have chosen; but no documentation

3 – amalgam was substandard care

 

2.         Treatment sheet

1 – filled out completely (including: diagram, anesthesia, nitrous oxide, treating DDSs, etc.

2 – some materials/comments missing

3 – entry has more than 2 gaps

3.         Good quality

1 – liners placed ( SE Bond, C2V, Dycal)

2 – no liners

4.         Prevention (check pink sheet)

1 – fluoride recommended and accepted

2 – fluoride recommended and not accepted

3 – fluoride not recommended

5.         How feeling call

1 – appropriate to call due to number of fillings, depth of filling, or difficulty for client

2 – call appropriate and not made

6.         File Organized

1-   file organized

2-   less than 3 pages misplaced or 3 old ICs not deleted

3-   more than 3 misplaced or 3 old ICs not deleted

 J. Composite Filling Evaluation Criteria

1.         Appropriate

1 – no other material would have been more appropriate – high decay rate, sufficient tooth support, very young/old client x-ray history shows decay progression through enamel, Diagnodent reading 35+ for occlusals, treatment appropriate with documentation

2 – plastic was a compromise that the client may have chosen, but no documentation

3 – plastic was substandard  care

 

2          Treatment sheet

1 – filled out completely (including: diagram, anesthesia, nitrous oxide, treating DDS etc)

2 – some material/comments missing

3 – more than 2 gaps in entry

3.         Good Quality

1 – SE Bond liners placed

2 – no liners

4.         Prevention

1 – fluoride recommended or documented if declined

2 – fluoride recommended and not accepted

5.         How feeling call (skip if not appropriate)

1 – appropriate to call due to number of fillings, depth of filling or difficulty for client

2 – call appropriate and not made

 

6.         File Organized

1-   file organized

2-   less than 3 pages misplaced or 3 old ICs not deleted

3-   more than 3 misplaced or 3 old ICs not deleted

 K. Oral Surgery Evaluation Criteria

1.         Blue sheet (if appropriate)

1 – all information filled in, all appropriate tests run

2 – 1-2 missing client information and tests

3 – 3 or more tests not run or recorded poorly

 

2.         Health History

1 – evidence of review and appropriate action if necessary (consults, prescriptions, etc.)

2 – tooth better saved, no notes on client discussion

3 – health history not updated or signed

3.         X-rays

1 – appropriate x-rays taken, clear, all necessary structures visible clearly

2 – appropriate x-rays taken, not as clear as could be

3 – x-rays not complete enough for surgery

4.         Diagnosis Treatment

1 – appropriate treatment provided, consent signed

2 – acceptable treatment provided, but other choice more appropriate

3 – inappropriate or too much treatment performed without and appropriate financial arrangement

 

5.         Treatment sheet

1 – narrative of client discussion written out as appropriate – choices, expectations, fees, what client said, as well as what treatment accomplished and the prognosis

2 – information present, but sketchy

3 – incomplete information

6.         Medications

1 – proper medications prescribed and noted in chart

2 – proper medications, notes incomplete

3 – incorrect or no medications prescribed

7.         Post Treatment

1 – “how feeling” call made if appropriate, client comfortable and noted in treatment sheet

2 – no follow up and client might have had discomfort

 

8.         File Organized

1-   file organized

2-   less than 3 pages misplaced or 3 old ICs not deleted

3-     more than 3 misplaced or 3 old ICs not deleted

L. Implants Evaluation Criteria

1.         Medical/Dental history reviewed with notations and signatures

l – many doctor notes, a sense of who the client is and what they expect, all medical conditions reviewed in detail, dentists signature

2 – some notes, entire form filled out and signed

3 – gaps, not signed

2.         Exam form (yellow) filled out

l – all sections complete

2 – gaps

3 – sketchy, lacks pertinent information, done by surgeon with no GP control

3.         Study casts (if appropriate)

1 – Taken if appropriate

2 – models taken

3 – no stent for surgical placement

4.         Intraoral camera

1 – before and after pictures taken clearly showing area

2 – before and after pictures taken but don’t show area

3 – missing or blurred before and after pictures

5.         Radiographs

l – complete series for all dentulous clients, all Pa’s show apices and decay x-rays show no proximal overlaps;  panoramic for edentulous clients, all films correctly exposed/developed, not elongated/foreshortened

2 – panoramic or all teeth can be evaluated using various portions of x-rays, although every x-ray is not ideal

3 – Some radiographic information not available due to distortion, cone cuts, lack of clarity,etc.

6.         Treatment sheet filled out

l – medical consult sent where appropriate, chart marked on front and in remarks section if necessary, written instructions from GP dentist to surgeon

2 – gaps

7.         Client Report

l – well organized, clearly written, reflects feelings and goals of client, include: diagnosis, prognosis, alternatives (if appropriate), risks, results if no treatment

2 – spells our treatment, overly technical and has few references to client’s feelings or goals

3 – incomplete

8.         Financial Arrangement

l – financial arrangement completed that meets our guidelines

2– no or poor financial arrangement made

9.         Technical competence

1 – good marginal fit, tooth not sensitive, good occlusion, good contacts, lab sheets filled out completely

2 – tooth sensitive

3 – poor fit or occlusion, pontic not well adapted to ridge, incomplete lab prescription

 

M.       Oral Sedation Evaluation Criteria

1.  Pre op assessment performed indicating review of health history and patient given pre- treatment instructions:

1 Yes

3  No

 

2.  Consent form(s) completed and signed:

1  Yes

3  No

 

3.  Treatment was justifiable for oral sedation:

1 Yes

3  No (Nitrous Oxide and distraction with movies should be attempted first)

 

4.  Oral Sedation form filled out properly:

1 Yes

3  No

 

5.  Treatment sheet notations made- comments concerning implementation, fee

1 Yes

3  No

 

6.  How-feeling telephone call made and documented ascertaining patient’s post- treatment status:

1 Yes

2 No

 

7.   File Organized

1-   file organized

2-   less than 3 pages misplaced

3-      more than 3 misplaced

 N. Feedback Report Evaluation Criteria

1.         Medical/Dental history reviewed with notations and signatures

1 – many doctor notes, a sense of who the client is and what they want form us, all medical conditions reviewed in detail.

2 – some notes, entire form filled out and signed

3 – few notes or signature(s) missing

2.         Medical conditions noted

1 – medical consult sent where appropriate, chart marked on front and in remarks section if necessary

2 – gaps

3.         Intraoral Camera

1 – all pictures taken – good pictures

2 – all pictures taken – one or more not clear or useless pictures not deleted

3 – some views missing, blurred

 

4.         Exam form (yellow or white) filled out

1 – all sections complete

2 – gaps in information

5.         Treatment sheet filled out

1 – medical consult sent where appropriate, chart marked on front and in remarks section if necessary

2 – gaps

6.         Radiographs

1 – complete series for all dentulous clients, all Pa’s show apices and decay x-rays show no proximal overlaps, Panoramic for edentulous clients, all

films correctly exposed/developed, not elongated/foreshortened

2 – panoramic or all teeth can be evaluated using various portions of various x-rays, although every x-ray is not ideal – not more than 2 x-rays not ideal.

3 – some radiographic information not available on more than 2 x-rays due to distortion, cone cuts, lack of  clarity, etc.

Client Report

1. – Well organized, clearly written, reflects feelings and goals of client, results if no treatment

2. – Spells our treatment, overly technical and has few references to client feelings or goals

3. – Incomplete

 

8.         Green or salmon sheet- treatment sequence

1-   all appointments outlined in detail

2-   most appointments outlined in detail

3-   not filled out although several appointments required

 

File Organized

1. -file organized

2. -less than 3 pages misplaced

3. -more than 3 misplaced

 

Level 3+ Assistant/EFDA Peer Review

Ratings System

Clinical quality review will be provided monthly for the first 3 months and then quarterly for the rest of the first years. During the second year, clinical quality will be assessed each six months.

The following system will be used. The front desk will be asked to search the computer database by code for clients to evaluates specific characteristics. Pull one set of charts for each participating dentist.

Each procedure has a series of characteristics and/or steps that will be evaluated.  Each characteristic/step will be defined on a check list and the lowest rating for any characteristic/step determines the evaluation for the whole procedure.

1 – excellent:  meets or exceeds all standards

2 – acceptable:  okay, no need to re-do, but nothing special

3 – needs repaired or replaced 

A.  Record audit

1.         Frequency   Charts are selected for each EFDA, C/S once every 6 months.  These charts are audited by the EFDA, C/S who is not the primary care hygienist of the patient.

2.         Method of selection:  All records for audit are selected at random by a secretary.

3.         Audit sheet please see the next page to indicate the charts needed for the record audit.  All questions are answered by the reviewing EFDA, C/S based on the findings in the patient record.  The audit sheet is signed by the reviewing hygienist then discussed with the EFDA, C/S of record..

 

B.  Secretaries’ Responsibility in Peer Review is to manage the timeliness of this project.  To do this:

1.         The dentist or office manager will alert you that it’s time for peer review.  Chairside/EFDA’s know in their meeting that its time for them to pick a week for peer review.

2.         Print the section of this level (lev2sec) for the peer review you are responsible for managing (GP dentists, Hygienists, Chairside/EFDA’s or Pediatric dentist)

3.         Talk to the hygienists to set a 2 day period for 1 hygienist to review charts.

4.         Pull a client’s chart who has had the treatment on the sheet done by each provider.  Put the criteria sheet on top of each chart.

5.         Print the summary page – need to print one per hygienist.

6.         Try to combine multiple procedures with one chart. Example emergency and new client exam.

7.         Stack the charts and sheets for each Chairside/EFDA with the summary sheet on top. Fill out the following information on the summary sheet: Name of provider who treated this stack of patient charts, name of the provider who will be reviewing these charts (need one summary page for each provider to use), the date you will be giving the charts to the reviewing provider, the deadline date for the charts to be completed.  Make sure the charts are not floating for a long period of time. Give a provider 72 hours (not counting weekends) to complete the charts. Write this out on a master sheet- each provider and dates assigned and due back.  Review at Friday meeting.

8.         Then give the charts to the provider at their meeting.  When the providers have finished reviewing their charts and recorded their ratings- the charts and the 2 summary sheets with ratings go back to the secretary.  She needs to average each provider’s ratings and then average the two ratings sheets together- this will end up with one set of numbers. These numbers need to be entered into the provider spreadsheet that was evaluated with the month & year.

9.         Charts can be removed from the office overnight for review, but must be returned the next day.

10.       The providers will meet during their normal meeting time to review the charts and comments from the providers.

11.       Check each day with each assistant to make sure assistant is on schedule.

12.       Set the next Wednesday after the review period is over and place the charts/results on the dentist’s desk.

13.       Print 4 copies of this provider’s ratings compared to previous years and give these pages to the office manager. The charts can now be filed.

14.       The EFDA, c/s will meet one hour before their normal meeting time to review the charts and comments from the EFDA, c/s.

15.       When the EFDA, c/s have finished reviewing their charts and recorded their ratings- the charts and the 2 summary sheets with ratings go back to the secretary.  She needs to average each EFDA’s, c/s ratings and then average the two rating sheets together- this will end up with one set of numbers.  These numbers need to be entered into the EFDA, c/s that was evaluated spreadsheet  with the month & year.

Who checks who:

All EFDAs check each other – example: Cass & Sarah check each other

All others are checked by 2 assistants

 Quality Evaluation Recording Form for Lev 3+Chairside/EFDA Peer Review

A-Chairside/EFDA – Radiography – Panoramic Evaluation Criteria

1.         Contrast

1 – excellent contrast, easy to read

2 – slightly dark/light

3 – contrast interferes with good diagnosis

2.         Timely

1 – taken at correct interval:  ages 6, 12, and 17

2 – wrong intervals

 

3.         Technique #1 head position

1 – normal shape of teeth

2 – slightly overlapped, elongated

3 – Blurred anterior teeth, teeth overlap, posterior teeth on 1 side too small/other side too large

 

4.         Technique #2 chin too high

1 – normal

2 – white line across teeth, condyles cut off, smile line exaggerated

 

5.        Technique #3 tongue in roof of mouth, lips together

1 – normal

2 – darkness at apices of tooth, shadow in center of film.

 

6.         File Organized

1-   file organized

2-   less than 3 pages misplaced

3-   more than 3 misplaced

 

B-Chairside/EFDA – Radiography – CMX Evaluation Criteria

1.         Contrast

1 – excellent contrast, easy to read

2 – slightly dark/light

3 – contrast interferes with good diagnosis

 

2.         Timely

1 – taken at correct interval:  5 yr intervals

2 – wrong intervals

 

3.         Technique #1 distortion

1 – no significant distortion

2 – slight problems elongation/overlapped

3 – several images either elongated or foreshortened, W.T. entirely on film, buccal and lingual cusps superimposed

 

4.         Technique #2 accuracy

1 – normal – molars lingual roots approximately same length as buccal roots of  upper molars.

2 – slight problems (example: distal of back molars not visable)

3 – cone cut, tooth overlap, blurred, zygoma superimposed on roots of maxillary

 

5.         Technique #3 film handling

1 – normal

2 – slight problems

3 – black line from banding, herring bone effect (film backwards), 2 images-same film, missing one or more shots

 

6.         File Organized

1-   file organized

2-   less than 3 pages misplaced

3-   more than 3 misplaced

 

C-Emergency – Chairside/EFDA Evaluation Criteria

1.         Blue Sheet

1 – all information filled in, if necessary, all tests run

2 – some missing client information and tests

3 – several tests not run or recorded appropriately

 

2.         Intra-oral picture

1 – clear view of problem and labeled

2 – attempted, could be better, not labeled

3 – no picture

 

3.         Health History Reviewed

1- Updated with date and intials, medical alert on front of chart

2- Gaps or

3- Not updated

 

4.  Treatment sheet

1 – complete narrative of client discussions written out on yellow treatment sheed – choices, expectations, fees, what client said, as well as what client wants and what treatment accomplished and the prognosis

2 – information present, but sketchy

3 – incomplete information

 

5.  Medications

1 – proper medications prescribed if needed

2 – proper medications prescribed, but not recorded on yellow tx sheet

3 – appropriate medications not prescribed

 

6. Client Chart Organized

1 – Yes

2 – Not more than 2 errors

3 – More than 2 errors

D-Chairside/EFDA – New Client Experience (Adult) Evaluation Criteria

1.         Case documentation complete

1 –  health hx reviewed, comments written on dental hx, Diagnodent readings

2 – documentation sketchy

3 – client does not return, 3 or more gaps

2.         Appointment Documentation

1 – treatment sheet filled out in detail

2 – forms filled out less clearly

3 – gaps

 

3.         X-rays

1 – taken as needed

2 – not clear, taken at improper interval

 

4.         Client motivation

1 – Chairside/EFDA documents recommendations to improve health, personal notes made in remarks

section on cooperation and personal profile

2 – effort documented to motivate client, success unknown

3 – no documented effort made

 

5.         Intraoral Pictures

1 – full face picture taken plus pictures of any problems

2 – some views missing or not clear

3 – no pictures

 

6.         File Organized

1-   file organized

2-   less than 3 pages misplaced

3-   more than 3 misplaced

 

E. Amalgam Filling Evaluation Criteria

1. Appropriate

1 – no other material would have been more appropriate – high decay rate, non esthetic area sufficient tooth support,  very young/old client, x-ray history shows decay progression through enamel, Diagnodent reading over 35 for occlusals

2 – amalgam was a compromise that the client chose

3 – amalgam was a compromise that the dentist chose

 

2.         Treatment sheet

1 – filled out completely (including: diagram, anesthesia, nitrous oxide, treating DDSs, etc.

2 – some materials/comments missing

3 – entry has more than 2 gaps

3.         Good quality

1 – liners placed ( SE Bond, C2V, Dycal)

2 – no liners

4.         Prevention

1 – fluoride recommended and accepted

2 – fluoride recommended and not accepted

3 – fluoride not recommended

5.         How feeling call

1 – appropriate to call due to number of fillings, depth of filling, or difficulty for client

2 – call appropriate and not made

6.         File Organized

1-   file organized

2-   less than 3 pages misplaced or 3 old ICs not deleted

3-   more than 3 misplaced or 3 old ICs not deleted

F. Composite Filling Evaluation Criteria

1.         Appropriate

1 – no other material would have been more appropriate – high decay rate, sufficient tooth support, very young/old client x-ray history shows decay progression through enamel, Diagnodent reading 35+ for occlusals

2 – plastic was a compromise that the client chose

3 – plastic was a compromise that the dentist chose client not offered better choice

2          Treatment sheet

1 – filled out completely (including: diagram, anesthesia, nitrous oxide, treating DDS etc)

2 – some material/comments missing

3 – more than 2 gaps in entry

3.         Good Quality

1 – SE Bond liners placed

2 – no liners

4.         Prevention

1 – fluoride recommended and accepted if appropriate

2 – fluoride recommended and not accepted

3 – fluoride not recommended

5.         How feeling call

1 – appropriate to call due to number of fillings, depth of filling or difficulty for client

2 – call appropriate and not made

 

6.         File Organized

1-   file organized

2-   less than 3 pages misplaced or 3 old ICs not deleted

3-   more than 3 misplaced or 3 old ICs not deleted

 

G-Sealants Evaluation Criteria

1.         Appropriate

1 – sealant appropriate – high decay potential.   Poor oral hygiene, or parent wants, x-ray history may show decay progression through  enamel

2 – sealants not recommended

 

2.         Treatment sheet documentation

1 – filled out completely (including: diagram, treatment, treating RDH) & materials used

2 – some materials/comments missing

3 – sketchy entry

 

3.         Prevention

1 – discussion with parent, fluoride recommended and accepted if decay potential a problem – at this  appointment or recall appointment

2 – fluoride recommended and not accepted

3 – fluoride not recommended but significant decay potential

 

4.         Diagnodent

1 – used and recorded

2 – no documentation of use

 

5.         File Organized

1-   file organized

2-   less than 3 pages misplaced

3-   more than 3 misplaced

 

H-Chairside/EFDA – PC appointment- Child Evaluation Criteria

1.         Case documentation complete

1 – comments written on yellow treatment sheet, continues treatment as needed,Diagnodent readings

2 – documentation sketchy

3 – client does not return, 3 or more gaps

2.         Pink sheet

1- Filled out with comments ( not yellow Tx sheet)

2- Filled out with no comments

3- Gaps, comments on yellow treatment sheets, intraoral camera

 

3.         X-rays

1 – Taken as needed

2 – Not clear, taken at improper interval

 

4.         Parent involvement

1 – Parent contact made, notes on pink sheet

2-  no documentation of contract motivation

 

5.         Fluoride/Sealents/Nutrition

1- Recommended, fluoride tabs or gel, prescribed if appropriate

2.  Gaps

3.  No noted recommendations

6.         Client motivation

1 – Chairside/EFDA documents recommendations to improve health, personal notes made in remarks section on cooperation and personal profile

2 – effort documented to motivate client, success unknown

3 – no documented effort made

 

7.         Intraoral Pictures

1 – full face picture taken plus pictures of any problems

2 – some views missing or not clear

3 – no pictures

 

8.         File Organized

1-   file organized

2-   less than 3 pages misplaced

3-   more than 3 misplaced

 

Hygienist Peer Review

Ratings System

Clinical quality review will be assessed each six months. The following system will be used. The front desk will be asked to search the computer database by code for clients to evaluates specific characteristics. Pull one set of charts for each participating dentist. Each procedure has a series of characteristics and/or steps that will be evaluated.  Each characteristic/step will be defined on a check list and the lowest rating for any characteristic/step determines the evaluation for the whole procedure.

1 – excellent:  meets or exceeds all standards

2 – acceptable:  okay, no need to re-do, but nothing special

3 – needs repaired or replaced

 

A.   Record audit

1.         Frequency – Charts are selected for each hygienist once every 6 months.  These charts are audited by the hygienist who is not the primary care hygienist of the patient.

2.         Method of selection – All records for audit are selected at random by a secretary.

3.         Audit sheet – please see the next page to indicate the charts needed for the record audit.  All questions answered by the reviewing hygienist based on the findings in the patient record.  The audit sheet is signed by the reviewing hygienist then discussed with the hygienist of record.

4.         Pediatrics—an extra series of charts designated alphabetically.

5.         Make sure all hygiensts here for next 10 days

 

B.  Secretaries’ Responsibility in Peer Review is to manage the timeliness of this project.  To do this:

1.         Alert office manager to let hygienist know at meeting that its time to pick a week for peer review.

2.         Print the section of this level (lev2sec) for the peer review you are responsible for managing (Dentist, Hygiene or Pediatric)

3.         Talk to the hygienist to set a 2 day period for one hygienist to review charts

4.         Pull a client’s chart who has had the treatment on the sheet done by each hygienist.  Put the procedure criteria sheet on top of each chart.

5.         Print the summary page – need to print one per hygienist.

6.         Special note: Try to combine multiple procedures into one chart.  Example: emergency and new client exam.

7.         Stack the charts and sheets for each hygienist with the summary sheet on top. Fill out the following information on the summary sheet: Name of hygienist who treated this stack of patient charts, name of the hygienist who will be reviewing these charts (need one summary page for each hygienist to use), the date you will be giving the charts to the reviewing hygienist, the deadline date for the charts to be completed.

8.         Then give the charts to the hygienist – tell that hygienist that you have put the charts on their desk and confirm the deadline for reviewing them.

9.         Charts can be removed from the office overnight for review, but must be returned the next day.

10.       Set the next meeting as the peer review discussion

11.       Check each day with each hygienist to make sure hygienist is on schedule

12.       When the hygienists finished reviewing their charts and recorded their ratings – the charts and the 2 summary sheets with ratings go back to the secretary. She needs to average each hygienist’s ratings and then average the two ratings sheets together – this will end up with one set of      numbers. These numbers need to be entered into the hygienist that was evaluated spreadsheet  with the month & year.

13.       Print 4 copies of this hygienist’s ratings compared to previous years and give these pages to the office manager so the charts can now be filed.

14.       The hygienist will meet one hour before their normal meeting time to review the charts and comments from the hygienists.

 

Peer review recording form Hygienist Peer Review

A-Hygiene – Radiography – Panoramic Evaluation Criteria

1.         Contrast

1 – excellent contrast, easy to read

2 – slightly dark/light

3 – contrast interferes with good diagnosis

2.         Timely

1 – taken at correct interval:  ages 6, 12, and 17

2 – wrong intervals

 

3.         Technique #1 head position

1 – normal shape of teeth

2 – slightly overlapped, elongated

3 – Blurred anterior teeth, teeth overlap, posterior teeth on 1 side too small/other side too large

 

4.         Technique #2 chin too high

1 – normal

2 – white line across teeth, condyles cut off, smile line exaggerated

 

5.        Technique #3 tongue in roof of mouth, lips together

1 – normal

2 – darkness at apices of tooth, shadow in center of film.

 

6.         File Organized (if no one has seen client after this appointment)

1-   file organized

2-   less than 3 pages misplaced

3-   more than 3 misplaced

B-Hygiene– Radiography – CMX Evaluation Criteria

1.         Contrast

1 – excellent contrast, easy to read

2 – slightly dark/light

3 – contrast interferes with good diagnosis

 

2.         Timely

1 – taken at correct interval:  5 yr intervals

2 – wrong intervals

 

3.         Technique #1 distortion

1 – no significant distortion

2 – slight problems elongation/overlapped

3 – several images either elongated or foreshortened, W.T. entirely on film, buccal and lingual cusps superimposed

 

4.         Technique #2 accuracy

1 – normal – molars lingual roots approximately same length as buccal roots of  upper molars.

2 – slight problems (example: distal of back molars not visable)

3 – cone cut, tooth overlap, blurred, zygoma superimposed on roots of maxillary

 

5.         Technique #3 film handling

1 – normal

2 – slight problems

3 – black line from banding, film light (film backwards), 2 images-same film, missing one or more shots

6.         Intra oral pictures

1-   full face picture, smile picture, upper & lower pictures, & area of concern pictures taken

2-   some views missing or not clear

3-   no pictures

 

7.         File Organized (if client not seen later by someone else)

1-   file organized

2-   less than 3 pages misplaced

3-   more than 3 misplaced

C. Emergency-Hygiene Evaluation Criteria

1.         Blue Sheet

1 – all information filled in, if necessary, all tests run

2 – some missing client information and tests

3 – several tests not run or recorded appropriately

 

2.         Intra oral picture

1 – clear view of problem and labeled

2 – attempted, could be better, not labeled

3 – no picture

 

3.         Health History Reviewed

1 – Updated with date and initials, medical alert on front of chart

2 – Gaps or not updated

 

4.  Treatment sheet

1 – complete narrative of client discussions written out on yellow treatment sheed – choices, expectations, fees, what client said, as well as what treatment accomplished and the prognosis

2 – information present, but sketchy

3 – incomplete information

 

5.  Medications

1 – proper medications prescribed if needed

2 – proper medications prescribed, but not recorded on yellow tx sheet

3 – appropriate medications not prescribed

 

6.  Files organized (unless client seen by someone else later)

1 – yes

2 – Not more than 2 errors

3 – More than 2 errors

D.  Hygiene- New Client Experience (Adult) Evaluation Criteria

1.         Case complete

1 – pre-medication taken, health hx reviewed, signed and dated, comments written in medical/dental 2 hx, all probing depths and mobility recorded, discussion on further treatment documented.

2 – client ready for further treatment

3 – client doesn’t complete appointment series or go on for further recommended treatment

 

2.         Appointment

1 – treatment sheet filled out in detail

2 – forms filled out less clearly

3 – gaps

 

3.         Pink sheet

1 – name and date filled out with comments (not on yellow tx sheet) pockets if none write “no pockets”, recession, cross out missing teeth

2 – filled out with no comments

3 – gaps, comments on yellow tx sheet

 

4.         Client motivation

1 – hygienist documents recommendations to improve health, personal notes made on remarks section of yellow health history form

2 – effort documented to motivate client, success unknown

3 – no documented effort made

 

5.         A client-centered experience

1 – all forms filled out, treatment sheet details what was accomplished, remarks sections shows personal profile, and discussion of any needed treatment

2 – all “client-centered” procedures accomplished, but now well documented or emphasis was on teeth, not person

3 – a tooth-centered experience

 

6.         File organized (if no one has seen client after this appointment)

1 – yes

2 – not more than 2 errors

3 – more than 2 errors

 Hygiene – New Client Experience (Child) Evaluation Criteria

1.         Case documentation complete

1 – pre-medication taken, health hx reviewed, comments written on dental hx, continues treatment as needed

2 – documentation sketchy

3 – client does not return

 

2.         Appointment documentation

1 – treatment sheet filled out in detail

2 – forms filled out less clearly

3 – gaps

 

3.         Pink sheet

1 –filled out with comments (not on yellow tx sheet)

2 – filled out with no comments

3 – gaps, comments on yellow treatment sheets, intraoral camera

 

4.         X-Rays

1 – taken as needed

2 – not clear, taken at improper interval

 

5.         Parent involvement

1 – parent contract made, notes on pink sheet

2 – no documentation of contract motivation

 

6.         Fluroide/Sealants/Nutrition

1 – recommended, fluoride tabs or gel, prescribed if appropriate

2 – gaps

3 – no noted recommendations

 

7.         Client motivation

1 – hygienist documents recommendations to improve health, personal notes made on remarks section on cooperation and personal profile

2 – effort documented to motivate client, success unknown

3 – no documented effort made

 

8.         Intraoral Pictures

1 – full face picture taken plus pictures of any problems

2 – some views missing or not clear

3 – no pictures

 

7.         File organized (if no one has seen client since this appointment)

1 – yes

2 – not more than 2 errors

3 – more than 2 errors

 

F.  Hygiene Recall Appointment (Adult)Evaluation Criteria

1.         Case Complete

1 – pre-medication taken, health hx review, comments written on dental hx, continues treatment, all probing depths and mobility recorded

2 – client ready for further treatment

3 – client doesn’t complete appointment series or go on for further recommended treatment

 

2.         Intraoral camera – if not already done

1 – full face, smile pictures

2 – pictures not clear

3 – no pictures

 

3.         Pink sheet

1 – filled out with comments (not on yellow tx sheet), 6 steps filled out

2 – filled out with no comments

3 – gaps

 

4.         Appointment

1 – treatment sheet and pink sheet filled out in detail

2 – forms filled out less clearly

3 – gaps

 

5.         Recall

1 – correct recall interval and need for dentist exam determined

2 – effort not documented, but seems appropriate 3 – 6 month interval for no reason

 

6.         Client motivation

1 – hygienist documents recommendations to improve health, personal notes made on pink sheet

2 – effort documented to motivate client, success unknown

3 – no documented effort made

 

7.         All documentation complete

1 – all completed

2 – 1 or 2 gaps

3 – 3 or more gaps

 

8.         File organized (if client not seen by someone else after this appointment)

1 – yes

2 – not more than 2 errors

3 – more than 2 errors

G.  Pediatric Recall Appointment – Hygienist

Evaluation Criteria

 

1.         Case complete

1 – pre-medication taken, health hx reviewed signed and dated, comments written in medical/dental hx, all probing depths and mobility recorded, discussion on further treatment documented.

2 – 1 or 2 gaps

3 – 3 or more gaps or child drops out

2.         Documentation

1 – treatment sheet and pink sheet filled out, health history reviewed, existing treatment documented, personal notes about client made and date, intraoral pictures taken

2 – forms filled out less clearly

3 – gaps

3.         X-rays

1 – taken as needed, clear

2 – not clear, taken at improper interval

4.         Parent involved

1 – parent contract made (both parent and Chairside/EFDA expectations), child’s and parent’s responsibility spelled out

2 – effort recorded with various degrees of success

3 – no documentation or effort made to motivate

5.         Fluoride/Sealants

1 – recommended and accepted, fluoride tablets or gel prescribed if appropriate

2 – recommended and reasons for declining documented

3 – gaps

6.         Nutrition

1 – documented improvement/good use of sugar

2 – documented effort with less positive response

3 – no documented effort

7.         Child’s Cooperation

1- assessment accurate, documented

2 – some effort, no clear recommendations documented

3 – no documentation

8.         Recall

1 – correct recall interval and need for dentist exam determined

2 – effort no documented, but seems appropriate

3 – 6 month interval for no reason

9.         Chart Organized (if client not seen later by someone else)

1. – yes

2. – not more than 2 errors

3. – more than 2 errors

H.  Hygiene – STM Evaluation Criteria

1.         Case complete

1 – appointment series correct (amount of time, interval between appointments)

2 – treatment completed, but spread out too much or too much time spent in appointments

3 – treatment not completed

 

2.         First appointment

1 – all forms filled out, treatment sheet details what was accomplished, disease worksheet completed with goals

2 – all procedures accomplished, but not well documented or emphasis was on teeth, not person

3 – a tooth-centered experience

 

3.         Medicaments

1 – all appropriate medicaments recommended: fluoride, Periogard, Listerine, Sensodyne, perioaide, nitrous used or declined, anes. used/declined and recorded

2 – some medicaments not discussed/provided

3 – no medicaments used or documented

 

4.         Perio referral – if needed

1 – letter, x-rays and detailed treatment sheet sent to periodontist

2 – letter sent, but could be more clearly, accurately written

3 – no letter sent

 

5.         Treatment sequence

1 – appointment sequence complete with no long unexplained lapses between appointments

2 – sequence completed, but over too long a period of time

3 – sequence not completed

 

6.         A client- centered experience

1 – client’s goal spelled out, “how feeling?”, call made after first appointment and recorded in treatment sheet, positive client statements recorded, notes on clients likes made

2 – same as 1, but less clearly spelled out

3 – gaps

 

7.         Motivation

1- STM client pink values attitude form filled out, medical/dental history reviewed with significant notations, client contract established in writing

2 – clients accepts STM, documentation incomplete

3 – STM not completed

 

8.         File organized (if client not seen later by someone else)

1 – yes

2 – not more than 2 errors

3 – more than 2 errors

I.  Sealants

Evaluation Criteria

 

1.         Appropriate

1 – sealant appropriate – high decay rate, poor oral hygiene, or parent wants, x-ray history may show decay progression through enamel

2 – sealants not recommended

 

2.         Treatment sheet documentation

1 – filled out completely (including: diagram, treatment, treating RDH) and materials used

2 – some materials/comments missing

3 – sketchy entry

 

3.         Prevention

1 – discussion with parent, fluoride recommended and accepted if decay potential a problem – at this appointment or recall appointment

2 – fluoride recommended and not accepted

3 – fluoride not recommended but significant decay potential

 

4.         Diagnodent

1 – used and recorded

2 – no documentation of use

 

5.         File organized (if client not seen by someone else later)

1 – yes

2 – not more than 2 errors

3 – more than 2 errors

 

Pediatric Peer Review

Ratings System

Clinical quality review will be provided monthly for the first 3 months and then quarterly for the rest of the first years. During the second year, clinical quality will be assessed each six months. The following system will be used. The front desk will be asked to search the computer database by code for clients to evaluates specific characteristics. Pull one set of charts for each participating dentist. Each procedure has a series of characteristics and/or steps that will be evaluated.  Each characteristic/step will be defined on a check list and the lowest rating for any characteristic/step determines the evaluation for the whole procedure.

1 – excellent:  meets or exceeds all standards

2 – acceptable:  okay, no need to re-do, but nothing special

3 – needs repaired or replaced

 

A.   Record audit

1.         Frequency   Charts are selected for each doctor once every 6 months.  These charts are audited by the dentist who is not the primary care dentist of the patient.

2.         Method of selection   All records for audit are selected at random by a secretary.

3.         Audit sheet   please see the next page to indicate the charts needed for the record audit.  All questions are answered by the reviewing doctor based on the findings in the patient record.   The audit sheet is signed by the reviewing doctor then discussed with the doctor of record.

4.         Pediatrics—an extra series of charts designated alphabetically.

 

B.  Secretaries’ Responsibility in Peer Review is to manage the timeliness of this project.  To do this:

1.         Alert office manager to let Dr.  know at doc mtg that its time to pick a week for peer review.

2.         Print the section of this level (lev2sec) for the peer review you are responsible for managing (Dentist, Dentist or Pediatric)

3.         Talk to the dentist to set a 2 day period for one dentist to review charts

4.         Pull a client’s chart who has had the treatment on the sheet done by each doctor.  Put the criteria sheet on top of each chart.

5.         Print the summary page  – need to print one per dentist.

6.         Stack the charts and sheets for each doctor with the summary sheet on top. Fill out the following information on the summary sheet: Name of DDS who treated this stack of patient charts, name of  the DDS who will be reviewing these charts (need one summary page for each dentist to use), the date you will be giving the charts to the reviewing dentist, the deadline date for the charts to be completed.

7.         Then give the charts to the dentist – tell that dentist that you have put the charts on their desk and confirm the deadline for reviewing them.

8.         Set the  peer review discussion

9.         Check each day with each dentist to make sure dentist is on schedule

10.       Charts can be removed from the office overnight for review, but must be returned the next day.

11.       The dentists will meet one hour before their normal meeting time to review the charts and comments from the dentists.

12.       When the dentists have finished reviewing their charts and recorded their ratings – the charts and the 2 summary sheets with ratings go back to the secretary. She needs to average each dentist’s ratings and then average the two ratings sheets together – this will end up with one set of numbers.

These numbers need to be entered into the dentist that was evaluated spreadsheet Excel:F:levelspeer review ratings.xls) with the month & year.

13.       Print 2 copies of this dentist’s ratings compared to previous years and give these pages to Jill the charts can now be filed.

 

Peer review recording form PediatricPeer Review

Find and print From T:/GP Dentists/Peer review/Peer review recording form.xls (be sure to print “Pediatric” tab)

A. Pediatric Recall Appointment Evaluation Criteria

1.         Case complete

1 – all stain removed, roots smooth, all restorations polished

2 – all stain removed, roots smooth, all restorations not polished

3 – significant stain removed, calculus not removed

 

2.         Motivation

1 – client excited, motivated, notes in remarks about person age of child considered in appointment clear contract established

2 – effort documented to motivate client, success unknown

3 – no documentation effort made

 

3.         Documentation

1 – treatment sheet and pink sheet filled out, health history reviewed, existing treatment documented

2 – forms filled out less clearly

3 – gaps

 

4.         X –rays

1 – taken as needed, clear

2 – not clear, taken at improper interval

 

5.         Parent involved

1 – parent contract made (both parent and hygienist expectations), child’s and parent’s responsibility spelled out

2 – effort recorded with various degrees of success

3 – gaps

 

6.         Fluoride/Sealants

1 – recommended and accepted, fluoride tablets prescribed if appropriate

2 – recommended and reasons for declining documented

3 – gaps

 

7.         Nutrition

1 – documented improvement/good use of sugar

2 – documented effort with less positive response

3 – no documented effort

 

8.         Child’s Cooperation

1 – assessment accurate, documented

2 – some effort, no clear recommendations documented

3 – no documentation

 

9.         File Organized

1-   file organized

2-   less than 3 pages misplaced

3-   more than 3 misplaced

 

B.  Np Child/Outside Referral Evaluation Criteria

1.         Introduction

1 – explain what we are going to do today and why and record conversation, review health/dental history, any other concerns, take photos full face and if can tolerate intraoral photos, take necessary x-rays, pink sheet filled out in detail.

2 – gaps

3 – lack of documentation

 

2.         Dentist Exam

1 – doctor comes in and does thorough exam discusses findings/recommendations with parent, charts existing conditions on yellow treatment sheet, makes notes in chart, Tx on Salmon Sheet.

2 – gaps

3 – lack of documentation

 

3.         Treatment Recommendations

1 – healthy (PC Prophy), In office tx (discuss/give handout w/Tx), Oral Sedation (Discuss/give oral sedation HO), Ambulatory Anesthetic (Discuss/give HO, set up consult)

2 – gaps

3 – lack of documentation

 

4.         Conclusion

1 – give out any other referral, Tx, etc, related handouts and discuss warranty

2 – gaps

3 – lack of documentation

 

5.         File Organized

1-   file organized

2-   less than 3 pages misplaced

3-   more than 3 misplaced

C. New Client Evaluation Criteria Evaluation Criteria

1.         Medical/Dental history reviewed with notations and signatures

1 – many doctor notes, a sense of who the client is and what they want form us, all medical conditions reviewed in detail.

2 – some notes, entire form filled out and signed

3 – no notes or signature(s) missing

 

2.         Medical conditions noted

1 – medical consult sent where appropriate, chart marked on front and in remarks section if necessary

2 – gaps in information

 

3.         Exam form (yellow) filled out

1 – all sections complete

2 – gaps in information

 

4.         Treatment sheet filled out

1 – medical consult sent where appropriate, chart marked on front and in remarks section if necessary

2 – gaps

 

5.         Radiographs

1 – panoramic at correct ages, all Pa’s show apices and all decay x-rays show no proximal overlaps, all films correctly exposed/developed, not elongated, foreshortened

2 – panoramic or all teeth can be evaluated using various portions of various x-rays, although every x-ray is not ideal

3 – some radiographic information not available due to distortion, cone cuts, lack of clarity, etc.

 

6.         Study casts (if appropriate)

1 – taken if appropriate, well trimmed, mounted if appropriate, bubbles removed, wax up completed if appropriate

2 – models taken

3 – no models

 

7.        File Organized

1-   file organized

2-   less than 3 pages misplaced

3-   more than 3 misplaced

 

D.  Treatment plan Evaluation Criteria

1.         Green Sheet – information

1 – all examination information transferred to green sheet and organized appropriately

2 – information present, but hard to follow

3 – incomplete information transfer

 

2.         Green Sheet – economics

1 – all procedure fees clearly marked

2 – all fees can be found through diligent effort

3 – one or more fees missing

 

3.         Green Sheet – diagnosis

1 – all information clearly organized and appropriate diagnosis written

2 – through effort the train of thought leading to the diagnosis can be figured out

3 – incomplete information transfer, unorganized treatment plan, inaccurate or incomplete diagnosis

 

4.         Diagnostic aids complete

1 – CMX, panoramic x-rays, study models, pulp tests present all necessary information

2 – no diagnostic models, but they are needed

3 – incomplete information base

 

5.         Green Sheet – Treatment Plan

1 – treatment plan solves existing problems consistent with clients priorities in a logical sequence

2 – gaps

 

6.         Green Sheet – treatment sequence

1 – all appointments outlined in detail

2 – most appointments outlined in detail

3 – not filled out although several appointments required

 

7.         Client Report

1 – well organized, clearly written, reflects feelings and goals of client, included:  diagnosis, prognosis, alternatives (if appropriate), risks, results if no treatment

2 – spells out treatment, overly technical and has few references to clients feelings or goals

3 – incomplete

 

8.         Financial Arrangement

1 – financial arrangement completed that meets our guidelines

2 – no or poor financial arrangement made

 

9.         File Organized

1-   file organized

2-   less than 3 pages misplaced

3-   more than 3 misplaced

 

E.  Amalgam Filling Evaluation Criteria

1.         Appropriate

1 – no other material would have been more appropriate – high decay rate, sufficient tooth support, very young/old client, x-ray history shows decay progression through enamel

2 – amalgam was a compromise that the client chose

3 – amalgam was a compromise that the dentist chose, decay cannot be demonstrated on x-ray

 

2.         Treatment sheet

1 – filled out completely (including: diagram, anesthesia, nitrous oxide, treating DDSs, etc.)

2 – some materials/comments missing

3 – sketchy entry

 

3.         Good quality

1 – liners appropriate for potential sensitivity, retentions, final polish

2 – carving has some anatomy

3 – overhang, contact open, poor anatomy, under or over contoured marginal ridge not formed,  all decay not removed

 

4.         Prevention

1 – fluoride recommended and accepted

2 – fluoride recommended and not accepted

3 – fluoride not recommended

 

5.         Anatomic form

1 – good contours, tooth like anatomy, no overhangs, marginal ridge at same height as adjacent tooth, closed proximal contact

2 – not good anatomic form

3 – chips out of restoration

 

6.         How feeling call

1 – appropriate to call due to number of fillings, dept of filling, or difficulty for client

2 – call not necessary

3 – call appropriate and not made

 

7.         File Organized

1-   file organized

2-   less than 3 pages misplaced

3-   more than 3 misplaced

 

F.  Composite Filling Evaluation Criteria

1.      Appropriate

1 – no other material would have been more appropriate – high decay rate, sufficient tooth support, very young/old client, x-ray history shows decay progression through enamel

2 – plastic was a compromise that the client chose

3 – plastic was a compromise that the dentist chose, decay can’t be demonstrated on x-ray

 

2.         Treatment sheet

1 – filled out completely (including: diagram, anesthesia, nitrous oxide, treating DDS etc)

2 – some materials/comments missing

3 – sketchy entry

 

3.         Good Quality

1 – good color match, liners appropriate for potential sensitivity

2 – poor color match, overhangs, poor occlusion

 

4.         Prevention

1 – fluoride recommended and accepted if appropriate

2 – fluoride recommended and not accepted

3 – fluoride not recommended

 

5.         Anatomic form

1 – good contours, tooth like anatomy, no overhangs, marginal ridge at same height as adjacent tooth, closed proximal contact

2 – not good anatomic form

3 – discoloration at margins, surface rough, pitted

 

6.         How feeling call

1 – appropriate to call due to number of fillings, depth of filling or difficulty for client

2 – call not necessary

3 – call appropriate, not made

 

7.         File Organized

1-   file organized

2-   less than 3 pages misplaced

3-   more than 3 misplaced

G.  Oral SurgeryEvaluation Criteria 

1.         Blue sheet (if appropriate)

1 – all information filled in, all tests run

2 – some missing client information and tests

3 – several tests not run or recorded appropriately

 

2.         Health History

1 – evidence of review and appropriate action if necessary (consults, prescriptions, etc)

2 – tooth better saved, no notes on client discussion

3 – gaps

 

3.         X-rays

1 – appropriate x-rays taken, clear, all necessary structures visible clearly

2 – appropriate x-rays taken, not as clear as could be

3 – x-rays not complete enough for surgery

 

4.         Diagnosis Treatment

1 – appropriate treatment provided, Dental/medical history reviewed

2 – acceptable treatment provided, but other choice more appropriate

3 – inappropriate or too much treatment performed without an appropriate financial arrangement

 

5.         Treatment sheet

1 – complete narrative of client discussion written out – choices, expectations, fees, what client  said, as well as what treatment accomplished and the prognosis

2 – information present, but sketchy

3 – incomplete information

 

6.         Medications

1 – proper medications prescribed and called in

2 – proper medications prescribed, but no record that client received them

3 – incorrect or no medications prescribed

 

7.         Post Treatment

1 – “how feeling” call made, client comfortable and noted in treatment sheet

2 – attempt made to contact, but not home, no actual contact

3 – no follow up and client might have had discomfort

 

8.         File Organized

1-   file organized

2-   less than 3 pages misplaced

3-   more than 3 misplaced

H.  Emergency Evaluation Criteria

1.         Blue Sheet

1 – all information filled in, all tests run

2 – some missing client information and tests

3 – several tests not run or recorded appropriately

 

2.         Diagnosis/Treatment

1 – appropriate treatment provided, no extensive treatment begun without an appropriate  financial arrangement

2 – acceptable treatment provided, but other choice more appropriate

3 – inappropriate or too much treatment performed without an appropriate financial arrangement

 

3.         Treatment sheet

1 – complete narrative of client discussions written out – choices expectations, fees, what    client said, as well as what treatment accomplished and the prognosis, did you recommend a prophy?

2 – information present, but sketchy

3 – incomplete information

 

4.         Medications

1 – proper medications prescribed and called in

2 – proper medications prescribed, but no record that client received them

3 – incorrect or no medications prescribed

 

5.         Post Treatment

1 – “how feeling” call made, client comfortable and noted in treatment sheet

2 – no follow up and client might have had discomfort

 

6.         File Organized

1-   file organized

2-   less than 3 pages misplaced

3-   more than 3 misplaced

 

 

I.  Preformed Crown

Evaluation Criteria

 

1.         Treatment Sheet

1 – filled out completely (including diagram, anesthesia, nitrous oxide, treating DDS)

2 – some materials/comments missing

3 – sketchy entry

 

2.         Appropriate

1 – more than 50% loss of tooth structure, high occlusal stress, maximum esthetics, failed existing crown

2 – should have been part of more extensive  rehabilitation that was not presented to client

3 – a filling would have been more satisfactory: cost/benefit analysis, bridge doesn’t replace second molar

 

3.         Technical Competence

1 – good preparation, fit

2 – adequate, could be better

3 – poor margins, contours, contacts, color

 

4.         Esthetics – anterior

1 – looks like tooth, good color match, and blends into arch – doesn’t stand out

2 – color match okay, but could be better, looks more like artificial crown than tooth

3 – poor margins, contours, contacts, color

 

5.         Correct Design

1 – adequate supporting tooth/bone structure, good contacts (no food impaction) convenience  centric and centric occlusion should match

2 – perio disease, evidence decay not controlled, design won’t withstand occlusal stress

 

6.         How feeling call

1 – appropriate to call due to number of fillings, depth of fillings or difficulty for client

2 – call not necessary

3 – call appropriate but not made

 

7.         File Organized

1-   file organized

2-   less than 3 pages misplaced

3-   more than 3 misplaced

 

 

J.  Unilateral/Bilateral Space Maintainer

Evaluation Criteria

 

1.         Space maintainer needed

1 – tooth/teeth extracted for abscessed/infection, crowding, orthodontic reasons w/orthodontist request (replacement tooth at least 1 ½ years from eruption).

2 – missing info

3 – no x-ray

 

2.         Appropriate

1 – appropriate appliance made (unilateral, bilateral), saving tooth not possible

2 – tooth could have been saved but parent didn’t want appliance

3 – no options presented to family, tooth removed and space maintainer placed

 

3.         Framework

1 – good design, fit, hygienic, self cleansing allows room for teeth to erupt

2 – some design errors

3 – poor fit, keeps falling out, causes soreness and pain

 

4.         Retention

1 – evidence that appliance is being checked at every PC appointment, cleaned and recemented when appropriate, removed when appropriate

2 – bent wire, moving under gum, falls out easily

3 – poor retention, not staying in, patient hits when bites down

 

5.         Esthetics

1 – patient comfortable can talk and eat with- how feeling call

2 – some problems, but ok

3 – no call made

 

6.         File Organized

1-   file organized

2-   less than 3 pages misplaced

3-   more than 3 misplaced

 

K.  Pulpotomy Evaluation Criteria

1.         Blue sheet/treatment sheet

1 – all treatment outlined in detail, including emergency appointment documentation of  discussion on possibility of extraction if indicated

2 – gaps

 

2.         X-rays

1 – before and post-treatment x-rays clear

2 – all x-rays present, some not ideal

3 – missing x-rays

 

3.         Diagnosis

1 – all information clearly organized and appropriate diagnosis written

2 – through effort the train of thought leading to the diagnosis can be figured out

3 – incomplete information transfer, unorganized treatment plan, inaccurate or incomplete diagnosis

 

4.         Economics

1 – all procedure fees clearly marked

2 – all fees can be found through diligent effort

3 – one or more fees missing

 

5.         Treatment

1 – no perforation of crown or root, conservative access, complete seal of pulpal chamber, client comfortable

2 – overfill

3 – fill more than 1mm short, client not comfortable at last contact

 

6.         Medications

1 – all medications prescribed and taken

2 – gaps

 

7.         Post Treatment

1 – “how feeling” call made, client comfortable and noted in treatment sheet

2 – no follow up and client might have had discomfort

 

8.         File Organized

1-   file organized

2-   less than 3 pages misplaced

3-   more than 3 misplaced