RDHM Dental Chairside Audit

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by:

• Department:
  Address

Standard 5

• 1. Has the patient been asked to confirm their

  Select name date of birth address other - please write in text field

  • name
  • date of birth
  • address
  • other - please write in text field

• Other: please comment

• 2) Was the intended procedure advised to the patient at today's visit prior to them starting treatment?

  Yes

  No

  N/A

• 3) Has the treating clinician matched the patients answers to the

  Select dental record Titanium record neither

  • dental record
  • Titanium record
  • neither

• 4) The radiographs have been confirmed as correct?

  Yes

  No

  N/A

• 5 a) Prior to referring for tests, such as radiographs, laboratory requests or other medical tests - has the clinician checked that:<br><br>All labels are labelled with a label consistent with the Titanuim information?

  Yes

  No

  N/A

• 5 b) The request form has The correct patient information?

  Yes

  No

  N/A

• 5 c) The request information been filled out correctly?

  Yes

  No

  N/A

• 5 d) If generated from Titanium - is saved before closing to ensure all entered details are stored?

  Yes

  No

  N/A

Standard4

• 2) Was the Medication Management Plan used if the patient indicated on the General Health Questionaire if they were on any current medications?

  Yes

  No

  N/A

Standard 8

• 1) On the General Health Questionnaire, has it been flagged for a Falls Risk Assessment form required to be completed<br>If yes, go to next question.<br>If no, go to standard 10

  Yes

  No

  N/A

• 2 ) Is there evidence of a Pressure Injuries Risk Assessment form been completed?

  Yes

  No

  N/A

Standard 10

• 1) On the General Health Questionnaire, has it been flagged for a Falls Risk Assessment form to be completed?<br>If yes, go to next question<br>If no, go to next section (3)

  Yes

  No

  N/A

• 2) Is there evidence a Falls Assessment Screening Tool been completed?<br>If no, go to section 3

  Yes

  No

  N/A

• 3) Is there evidence of a Falls Risk Assessment Tool (FRAT) completed?

  Yes

  No

  N/A

Standard 4

• 1) Was any medication prescribed during appointment?<br>If no, please go to standard 6

  Yes

  No

  N/A

• 2) Is there evidence to confirm the medication was checked before prescribing?<br>Tick all relevant methods undertaken

  written medication history

  verbally confirmed with the patient

  both

  neither

• 5) Did the patient receive discharge medication education?

  Yes

  No

  N/A

Standard 6

• 1 Was handover witnessed during the appointment?<br>If no, select NA for all questions and go to section 4

  Yes

  No

  N/A

• 2 Were any of the following clinical handover procedures applicable to this appointment?

  referral to another department

  referral for tests(Radiology/Lab)

  transfer to another facility

  transfer with in department

• 3. What process was used to deliver handover?

  face to face discussion with clinician (if yes, go to next question)

  form (if yes, go to Q5)

  face to face and form (if yes, go to Q5)

  discharge letter ( if yes, go to Q5)

  neither

• If neither was selected, please explain why?

• 4 If a face to face discussion occurred with clinician ,was the information recorded in the patients record?<br>If yes, go to next question (4b)

  Yes

  No

  N/A

• 4 a) If yes, was it recorded in

  Select titanium hard copy record both other

  • titanium
  • hard copy record
  • both
  • other

• If other was selected, please explain where was Handover documented?

• 4 b) Was handover structured according to ISBAR principles <br>(I) identity or introduction. Establish the name and role of the person giving and relieving the information and the correct identity of the patient<br>(S) the clinical situation <br>(B) the background of the patient <br>(A) the clinical assessment (including observations)<br>(R) the recommendation or proposed plan including identification of risks .

  Yes

  No

  N/A

• 5) Is there evidence the patient has been involved during the clinical handover process?

  Yes

  No

  N/A

Standard 3

• 1) Soiled instruments are wiped immediately after use?

  Yes

  No

  N/A

• 2) Instruments are checked ensuring they are free of debris before placing in cassettes or containers?

  Yes

  No

  N/A

• 3) Spatulas are cleaned and wiped of dental material?

  Yes

  No

  N/A

• 4) Materials such as wedges, cotton pellets and floss are removed from cassettes before transferring to dirty hold?

  Yes

  No

  N/A

Chairside cleaning

Chair

• Top surface

  Yes

  No

  N/A

• Behind headrest

  Yes

  No

  N/A

• Side Panels

  Yes

  No

  N/A

• Under arm rest

  Yes

  No

  N/A

Bracket table

• Under tray and rim

  Yes

  No

  N/A

• Side edge

  Yes

  No

  N/A

• Top surface

  Yes

  No

  N/A

Switch Panel

• Below switch panel

  Yes

  No

  N/A

• Bottom surface

  Yes

  No

  N/A

• Top surface

  Yes

  No

  N/A

Hand piece bracket

• Outer surface

  Yes

  No

  N/A

• Hand piece cradle and buttons

  Yes

  No

  N/A

• Hand piece tubing

  Yes

  No

  N/A

Light

• Arm

  Yes

  No

  N/A

• Light cover and switch

  Yes

  No

  N/A

• Handles

  Yes

  No

  N/A

Bench tops

• Clean area

  Yes

  No

  N/A

• Contaminated area

  Yes

  No

  N/A

• Clerical area

  Yes

  No

  N/A

Suction bracket

• Outer surfaces

  Yes

  No

  N/A

• Underneath

  Yes

  No

  N/A

• Hand piece cradle and buttons

  Yes

  No

  N/A

• Hand piece tubing

  Yes

  No

  N/A

Cuspidor

• Inner bowl and upper ridge

  Yes

  No

  N/A

• Suction filter

  Yes

  No

  N/A

X-rat unit

• Cone

  Yes

  No

  N/A

• Head

  Yes

  No

  N/A

• Arm

  Yes

  No

  N/A

• Trigger button

  Yes

  No

  N/A

END OF SURVEY