504 - Battle of the Irrigants: An Audit to assess the type of irrigants used in the management of alveolar osteitis
G Jeyatheswaran J Gillespie H Roberts
Presented by: Gabby Jeyatheswaran
Community Dental Service CwmTaf
Introduction Chlorhexidine is often used as an antimicrobial irrigant in the management of alveolar osteitis. However, the potential for chlorhexidine to cause an anaphylactic reaction can easily be overlooked. Given the global increase in reporting of anaphylaxis incidents after chlorhexidine use, dentists should be more aware of its potential adverse effects. Clinicians should also be aware of the lack of evidence to demonstrate the benefits of irrigating with chlorhexidine in the management of alveolar osteitis and should be aware of the recommended use of saline as an alternative to chlorhexidine. Method A retrospective audit was carried out to assess the types of irrigant being used in the management of alveolar osteitis by dentists within two Urgent Dental Centres. Based on the current evidence base and SDCEP guidelines, it was expected that 100% of alveolar osteitis cases would be irrigated with saline. Through electronic record analysis, 32 alveolar osteitis cases were identified from the 14th April 2020 to 19th November 2020 and 26 cases were identified from 10th December 2020 to 17th February 2021 during the second cycle. Results The results of the first audit cycle suggested that out of 32 alveolar osteitis cases, 17 cases were irrigated with chlorhexidine, 11 cases were irrigated with saline, 1 case was irrigated with sterile water and 3 cases were not irrigated. The results of the second cycle suggested that of the 26 alveolar osteitis cases, 24 cases were irrigated with saline and 2 cases were irrigated with chlorhexidine. Conclusions The results suggest that the vast majority of clinicians are now managing alveolar osteitis by irrigating with saline. This suggests that saline may be more readily available in clinics than before and clinicians have decided to alter their clinical practice in line with the current evidence base and guidelines. This change in clinical practice should reduce the chance of an adverse incident occurring.
Consent Statement: There are no details on individual patients reported within the abstract.
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479 - The use of radiographic imaging for suspected midface fractures in the Accident & Emergency Department
N Gallagher CJ Lloyd
Presented by: Nicola Gallagher
Glan Clwyd Hospital
Introduction - Facial injuries frequently present in A&E where it has become common practice to request radiographic imaging prior to specialist referral. Facial bone x-rays are frequently requested if a midface fracture is suspected but previous studies indicate that only 30% of requests are justified. In response to requests for plain film imaging it has become common practice to take at least two occipitomental views (OM, OM30). There are studies demonstrating that a single OM30 view is sufficient, although computed tomography (CT) is now the gold standard. This study investigates the use of radiographic imaging for suspected midface fractures. Methods - Data was retrospectively examined for a 10-week period for the requests of facial bone imaging for suspected midface fractures. Results - There were 76 requests for plain film imaging (69 adults, 7 children), midface fractures were reported for 6 (8%) patients (all adults). The number of images taken varied; with one, two, three and four views taken for 12 (16%), 54 (70%), 10 (13%) and 1 (1%) patient respectively. There were 53 requests for facial CT (51 adults, 2 children). Midface fractures were reported for 17 (32%) patients (16 adults, 1 child), 10 of which were isolated nasal bone fractures. A&E doctors requested 97% of images, only 4 (3%) patients had an OMFS review prior to imaging. Conclusion - Radiographic imaging for facial injuries is common. A positive finding of a midface fracture from plain film imaging is low (8%). This could suggest that some requests are unjustified and radiographic imaging is potentially overused. Midface fractures were detected in 32% of facial CT, however 59% (n=10) of these were isolated nasal bone fractures for which radiographic imaging is not advised. These results have highlighted a potential need for an improved clinical pathway for suspected midface injuries. The result is a collaborative project between OMFS, A+E and Radiology that will improve patient care.
Consent Statement: There are no details on individual patients reported within the abstract.
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469 - Reducing risk of harm- a quality improvement in theatre listing
A Dahill K Maxwell T Sato E Woolley
Presented by: Anna Dahill
Glan Clwyd Hospital
Introduction Theatres are a complex healthcare setting with a potential for risk of errors and harm to patients. A significant number of errors in the OMFS theatre lists was noted which were deemed a potential factor contributing to the increased risk of wrong side operating and inefficient use of theatre time. It was clear that an improvement in the accuracy of the information in theatre lists was needed. The aim of the quality improvement project was to audit the error rate and ascertain the nature of the errors to inform and enable an improvement initiative to improve safety and efficiency in theatre. Methods Retrospective data was collected from electronic records for Maxillofacial Day Case Lists for September-November 2018. An alteration from the procedure listed to that recorded in the operation notes was noted. The patients file was looked at to find the reason for the error. This was re-audited in June-July 2019. Results The initial audit showed that 15 of 145 cases were incorrectly listed in September-November 2018, giving an error rate of 10%. The most common cause of error was found to be unclear booking forms. After feedback from the Maxillofacial team booking forms were altered to make them clearer, and both secretaries and clinical staff were educated on the best way to complete/understand them. A re-audit target was set of an error rate of less than 5% by August 2019. From June to July 2019 there were 56 cases and 3 errors, giving an error rate of 5%. Conclusion There has been a reduction in the theatre list errors to 5%. Going forward, forms to complete in theatre after an error is noted would help unpick the cause. Education on the correct way to fill in and read booking forms should be continued. A reaudit is suggested with a target to reduce the error rate further. This audit quality improvement project shows the importance of a multidisciplinary approach to patient care and taking an active role in quality improvement of the healthcare.
Consent Statement: There are no details on individual patients reported within the abstract.
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525 - Lessons from Lockdown: An Audit of the Effect of Covid19 on Record Keeping in the CDS
S Ghafoor
Presented by: Saiba Ghafoor
St. David's Hospital
Introduction: In the CDS, many patients have complex medical and social histories, which must be recorded in accurate clinical notes in order for patients to be treated safely and effectively. Practice changed greatly due to the Covid19 pandemic, with no routine care taking place and patients being triaged and often treated remotely. Aim: The aim of this audit was to assess the quality of clinical record keeping, in relation to Covid19. Methods: Data for the audit cycle was collected in July 2020. Records from 10 emergency appointments over at least 5 different days were randomly selected from each of the 8 dentists. I assessed the quality of clinical record keeping against 8 parameters for remote patients and 9 parameters for face-to-face patients, with 6 out of 8, or 7 out of 9 parameters needing to be met to be deemed acceptable. The standard was set at 90% of records to be acceptable. Results: Only 55% of records were deemed acceptable, which is was below the 90% standard set. 3 of the dentists met the 90% standard individually. Record keeping was audited previously at this site between October 2019 and January 2020, where an improvement from 60% to 80% acceptable records was seen. This audit showed that the standard was still not being met, so the results were disseminated and a new Covid19 triaging template created on ‘SOEL,’ which included the parameters being assessed. Re-audit is on going to assess if this improved record keeping. Conclusion: This audit had some modified parameters in comparison to the previous audit cycles to account for the circumstances of remote triaging for emergency patients only, in line with guidance for Covid19 record keeping. However, on the whole, this audit shows that record keeping deteriorated significantly, which is likely reflective of the unique pressure the CDS was under and the unprecedented nature of the situation.
Consent Statement: There are no details on individual patients reported within the abstract.
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483 - Namibia: Developing Partnerships for Children’s Oral Health
C Pari IG Johnson O Jacob A Patel S Thomas N West L Sidhu F Stegman O Olowofoyeku N Umbaru J Hall
Presented by: Caron Pari
Cardiff Dental Hospital
Introduction: Work was carried out in 2019, as part of Phoenix project with the University of Namibia, to determine the state of paediatric oral health in Namibia and thereafter to identify opportunities for oral health promotion. Namibia is described by the World Bank as an upper-middle-income country but has extreme socio-economic inequalities. It has a young population with approximately two fifths under the age of 15. More than 11 indigenous languages are spoken in Namibia. Method: Data was collected collaboratively by a team in 7 locations across Namibia, including schools and orphanages. Oral health assessment and questionnaire was completed using a standardised procedure following assessor training. Children participated in activities for oral health promotion and were provided with oral health advice. Children with urgent dental needs were referred for treatment in local hospitals. Results: A total of 402 children were screened with a mean age of 10 years. A large proportion of children had dental caries experience and treatment need • 64% of children aged 2-10 years had dental caries experience • 58% of children aged 6-10 years were deemed to need prompt treatment • Over 25% reported dental pain in the preceding 12 months • 66% of the 380 who responded to questions about dental visits had never seen a dentist Conclusion: A large proportion of children had dental caries experience and treatment need. Younger children appear to be at particular risk from dental caries. Engagement is needed to encourage dental attendance and prevention. Oral health promotion activities for school children in Namibia have been created in line with learning from this project. Teams in Cardiff and Namibia have been working collaboratively with arts students to develop language free, culturally appropriate communication resources for local dental teams to use with children to encourage prevention and engagement with dental care.
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