Audit

EC.02.02.01 EPs 3, 4, 5, 7

Instrument Cleaning: Maintain sharps containers in a manner that reduces risk of exposure

Instrument Cleaning: Label basins containing instrument cleaning solution

Instrument Cleaning: Include the expiration date or information related to the diluted cleaning solution

Radiation: Follow organization’s policy on the wearing of dosimeters and testing/inspecting of lead aprons

Eye Wash Station: Ensure accurate labeling of faucets and water temperature

EC.02.04.03 EPs 1, 3, 4

Before Initial Use of Equipment: Test and document safety and function of dental equipment

Before Initial Use of Equipment: Educate/train staff on the use of dental sterilizers per guidelines

Inspect Equipment Identified on Inventory: Tag all equipment (e.g. curing light, amalgamator)

Inspect Equipment Identified on Inventory: Tag and document equipment for annual maintenance inspection

Inspect Equipment Identified on Inventory: Document evidence of preventive maintenance

Conducts Performance Tests on Sterilizers (general performance testing): Establish sterilizer policy that follows the recommendations of the manufacture or state and review with staff

Conducts Performance Tests on Sterilizers (general performance testing): Perform correct use of biological testing media, fully document all details on dental sterilizers’ spore tests, and validate the accuracy of tests using controls

Conducts Performance Tests on Sterilizers (general performance testing): Educate/train dental staff on how to perform, read, and retest biological testing

Conducts Performance Tests on Sterilizers (general performance testing): Record all information and avoid gaps in spore testing logs

Conducts Performance Tests on Sterilizers (general performance testing): Ensure any outside laboratory’s spore tests reports are timely and accurate

Conducts Performance Tests on Sterilizers (general performance testing): Provide appropriate in-use/non-expired supply levels needed for sterilizer tests

HR.02.01.03 EPs 3, 5, 10, 16, 21

The organization verifies staff qualifications. For care providers required to be licensed, certified, or registered that do not practice independently (e.g. dental hygienists, dental assistants), primary source verify their license, registration, or certification at time of hire and renewal.

"The organization verifies staff qualifications. Verify evidence of education (e.g. dental hygiene school) o NOTE: does not require primary source verification"

"Primary Source Verification: Before granting initial, renewed, or revised privileges, and at the time of licensure expiration, primary source verify licensed independent practitioners (e.g. dentist) for:
• training
• licensure"

Privileges Requirements for LIPs: Ensure there is a written statement that no health problems exist that could affect a LIP’s ability to perform their requested privileges

Privileges Requirements for LIPs: Query the National Practitioner Data Bank

Privileges Requirements for LIPs: Renew privileges every 2 years

IC 02.02.01 EPs 1, 2, 4

"Cleaning and Disinfecting:
• Follow manufacturer’s recommended frequency when cleaning and performing low-level disinfection of dental supplies and devices"

"Cleaning and Disinfecting:
• Follow manufacturer’s recommended contact time for surface disinfection of operatories between patients"

Requirements for sterilizing dental equipment, devices, and supplies: Include dental areas in an organization’s sterilization policy

Requirements for sterilizing dental equipment, devices, and supplies: Establish methods by which patients can be identified in cases of sterilization failure, and instruments can be retested if there is a previous failed test

Requirements for sterilizing dental equipment, devices, and supplies: Pack sterile instruments to avoid perforations

"Storing dental equipment, devices, and supplies:
• Establish and follow a monitoring protocol for separating expired instruments/supplies from sterilized instruments/supplies (e.g. sutures, composite tip, fluoride, copalite, restorative materials, indicator strips, disinfection cleaners)"

Requirements for sterilizing dental equipment, devices, and supplies: Use different personal protective equipment (PPE) for patient care versus sterilization areas

LD 04.01.07 EP 2

Ensure that policies and procedure used for dental services are consistent with the organization’s policy and procedures (e.g. patient health history requirements for oral surgery procedures), and are communicated to all staff

Ensure that patient consent forms used for dental services are part of an organization’s policies and procedures

MM 03.01.01/EP 6, 8

"Medication Security:
• Prevent unauthorized individuals from obtaining medications, consistent with law and regulation recommendations, including mobile dental carts"

"Medication Security:
• Include dental in the periodic inspection of dental medication storage areas"

PC 01.02.07 EP 1

"Comprehensive Pain Assessment:
• Ensure pain assessment for dental patients is consistent with organization’s policy"

"Comprehensive Pain Assessment:
• When indicated, refer or conduct a comprehensive pain assessment and document in the patient’s record"

"Comprehensive Pain Assessment:
• Educate/train dental staff on pain policy (e.g. scale to use)"

RI 01.03.01/EP 13

"Informed Consent Policy and Procedures:
• Ensure the patient dental consent form:
o documents that the patient was informed of benefits, risks, or alternatives
o includes minors
o covers both the procedure and any sedation required
o is used with each new dated procedure
o is complete with organization required information (e.g. tooth number)"

"Informed Consent Policy and Procedures:
• Document that the patient dental consent form was completed"

UP 01.03.01/EPs 1, 5

"Conduct and Document a Time-Out:
• Educate/train dental staff on the organization’s policy assuring that all components of the time-out are conducted"

"Conduct and Document a Time-Out:
• Document that the time-out was conducted prior to procedure"

"Conduct and Document a Time-Out:
• Perform a time-out when conducting invasive procedures (e.g. extractions)"

Additional comments / observations:

Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.