Title Page

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by:

  • Department:

Section 2 - beginning of appointment

Standard 5

  • 1. Has the patient been asked to confirm their

  • Other: please comment

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

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

  • 4) The radiographs have been confirmed as correct?

  • 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?

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

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

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


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

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

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

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)

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

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

Section 3 - during the appointment

Standard 4

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

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

  • 5) Did the patient receive discharge medication education?

Standard 6

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

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

  • 3. What process was used to deliver handover?

  • 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)

  • 4 a) If yes, was it recorded in

  • 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 .

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

Section 4 - end of appointment

Standard 3

  • 1) Soiled instruments are wiped immediately after use?

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

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

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

Chairside cleaning


  • Top surface

  • Behind headrest

  • Side Panels

  • Under arm rest

Bracket table

  • Under tray and rim

  • Side edge

  • Top surface

Switch Panel

  • Below switch panel

  • Bottom surface

  • Top surface

Hand piece bracket

  • Outer surface

  • Hand piece cradle and buttons

  • Hand piece tubing


  • Arm

  • Light cover and switch

  • Handles

Bench tops

  • Clean area

  • Contaminated area

  • Clerical area

Suction bracket

  • Outer surfaces

  • Underneath

  • Hand piece cradle and buttons

  • Hand piece tubing


  • Inner bowl and upper ridge

  • Suction filter

X-rat unit

  • Cone

  • Head

  • Arm

  • Trigger button


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