Usually there are many unwritten details with any given treatment plan. We are reliant on the doctor to follow that plan carefully so that nothing gets missed. The doctor is checking and then cross-checking again. It’s up to the doctor to be sure everything is in order on the case. If not, things can fall through the cracks.

This commonly used “memorization manually” method is not only very laborious and inefficient but also dangerous because it is not possible for the doctor to catch every nuance. It requires someone to check the chart repeatedly to see that everything has been followed through properly.

In addition, handwriting side notes are not only hard to read but they are a dead end. You still have to stop at the end to transcribe it all again into the letter to the dentist.

Multiple things occur when treatment planning, and many of them are hidden. Here are a couple of brief examples:

Commonly known:

1. Financial arrangements are made
2. Appointments are scheduled
3. Insurance is billed

Hidden:

1. Healing periods
2. Lab appliances that are needed
3. The need to see another provider for care in the interim – timing/timelines
4. When the patient will return to the general dentist

Often we will have 3 or 4 places in which we keep this information, as well as refer back to it, because some of the things are relevant for only certain areas of the practice. Some info is stored in our minds, some things are simply repeated, and some stuff is stored in a separate tracking mechanism (such as lab info).

Where do we keep the master plan? Often practices have a separate page outside of the practice management program in which to keep the clinical treatment plan. Traditionally this is a special page where the plan is stored from a clinical perspective and is updated and kept as a master log. This page doesn’t translate itself, nor does it transcribe itself, so therefore it needs to be translated by an insurance or financial specialist into the practice management software. On top of this, a transcriptionist also has to transcribe what the doctor has already repeated. This outcome (now from a third party’s perspective) is too detailed for the scheduling and billing system and also too casual and rough for the general dentist to read. It becomes jargon that is only useful to the team internally. Even if your practice is paperless, this part is still a document and just about as useful as a piece of paper. To add to this, it also needs to be scanned in, so then it becomes an image taking up computer space.

Click here to find out how PANDA automates transcribing treatment plans

The primary problem with the traditional treatment planning method is that it is inefficient. Sure, the “old-fashioned way” has worked for years, but it is actually very redundant. Clinical documentation doesn’t have to be treated as if it’s a new and unique process each and every time – it can be greatly streamlined! If we were to map the records out in advance in the form of a letter, then translate what each plan means into insurance codes (yes, going the opposite direction of typical thinking) then store them, we would have a clear library of plans so that they could be handled more effectively by the staff. This greatly eases the pressure put upon the doctor. This is not “giving the staff something they can’t handle” either; rather, it is a process that gives them something very useful and makes it tangible so that they can proceed – and succeed – simply and predictably every time. Automating a repetitive process – even taking into consideration the different variables and nuances along the way – is something every practice should do as a practicality. With digital records being a mandate in the next few years, why not get a leg up on it now? And just think of the ROI (Try the Calculator)!

One thing that can really help is to allow the individual team members to have a sense of accomplishment. Take a step back and forget about the outcome of the job performance for a moment and ask the staff member to come up with their own creative solutions based on what they see that needs to be done. It’s not realistic to expect this to happen during hectic patient care hours, but rather just bring up the topic so that they have in the back of their minds that it’s okay to think outside the box. Encourage them to stop and think and become part of the solution, even if it’s simply a brainstorming session. Once the solutions have been discussed and agreed upon, set simple goals so that they then have to follow through in an actionable way. When they can see the goals that have been laid out ultimately met with success, they will begin to feel better about their job performance. Marked progress, even in baby steps, can spread like wildfire, too – especially when the positive outcome is noticed by others. Other people will want to do just as well, sort of like when you smile at others and they smile back. It can be infectious! Indirectly they will have a new attitude and usually their job performance will be enhanced from then on. It’s a subtle spark that can set a mood and increase morale for the office.

A study conducted by RDH eVillage found that 25% of hygienists sharpen their instruments less frequently than once per month, and half of those quarterly or less. Yet, being sharp is critical! Imagine trying to cut a crown prep with a dull burr or steak with a butter knife. Imagine trying to remove hard, crusty debris with scaling and root planing (SRP) from a tooth root beneath ulcerated, infected soft tissue using dull curettes.

When you consider that much of this debris remains hidden from view beneath gingiva, entirely dependent upon a very sensitive tactile touch for removal, the quality of instrument maintenance becomes of critical importance. And, just like our steak example, using a dull instrument can result in torn, abraded tissue. However, unlike our steak example, performing SRP procedures with dull instruments will also result in …

• Burnished residual calculus that provides a safe, resistant haven for infection-causing bacteria
• Excessive instrumentation strokes
• Probable discomfort for the patient enduring that SRP
• With approximately 70% to 80% of our population suffering from periodontal disease, and our registered dental hygienists being charged with providing the nontherapeutic periodontal treatment, how can we not address the critical state of the instruments our hygienists use to provide this service?

When the RDH eVillage study queried hygienists as to the challenges of maintaining sharp instruments and replacing worn instruments, the vast majority of responses clearly cited cost as the reason. Interestingly, while many hygienists blamed their doctor for not providing the necessary funds, they also blamed themselves. The study cited direct quotes from many hygienists complaining that “other” hygienists in their offices ruined instruments with improper sharpening techniques. Dentists who regularly air their frustrations on blog posts and in chat rooms share these concerns. Apparently, many hygienists are ineffective at the skill of instrument sharpening, and hygienists themselves acknowledge this.

The challenge

It is apparent that we have a major disconnect here, and yet the dilemma is understandable. While hygienists learn how to sharpen instruments in school, this skill does not always carry over to private practice. While many hygienists are passionate about their skill level and are indeed very skilled, just as many, if not more, struggle with sharpening from both a time and skill perspective. Here are two of the results of improper instrument sharpening:

1. Improperly sharpened instruments can cause patient injury (torn tissue, residual calculus, and bacteria) and hygiene injury (unnecessary repetitive wrist movement). No wonder hygienists are frustrated!
2. Improperly sharpened instruments can also cause excessive and unnecessary expense from prematurely ruined instruments. No wonder doctors are frustrated!

The solution

Fortunately, there is a solution that not only helps solve the immediate problem of maintaining and protecting instrument inventory, but it also helps to unite doctors and hygienists as partners in the practice.

Here is what you can do to improve and correct the situation in your office:

1. Ask your hygienist to read this article, as well as this article’s companion article in the May issue of RDH magazine, Be Sharp! Are you on the cutting edge?
2. Discuss the situation in your office with your hygienist. Chances are your hygienist will really appreciate your interest in this problem.
3. Approach the situation from a business perspective and ask your hygienist to do the same. Ask your hygienist to research the office hygiene instrument inventory (see the RDH Instrument Inventory Plan at the end of this article) to prepare for your next meeting.
4. At the second meeting, review your hygienist’s instrument findings and proposal. Identify needs. Make a plan. If someone in your office is responsible for supply ordering, that person can be included in this meeting as well.

Once you’ve identified your need, determine a plan for correction. Like a good treatment plan, prioritize your needs for instrument maintenance and replacement. Assign a dollar amount on a regular (monthly) basis and charge your hygienist with staying within (or below) that budget. You may not get all instruments “fixed” immediately, but once you have a plan, your hygienist can implement — and should be responsible for — continual upgrades at regular intervals. Share your new plan with appropriate team members so everyone is on the same page.

Another great solution is Nordent’s revolutionary new sharpening service. The Nordent company manufactures hygiene instruments and sharpeners and has, for years, been committed to helping hygienists and dentists maintain effective, quality sharpness. Their new Relyant line includes a sharpening system that is a real problem-solver. While Nordent’s sharpening service will sharpen any brand of instrument, they will sharpen any Relyant instrument for free for the life of the instrument. Then, when the instrument is no longer safe to sharpen, the company will discount your replacement. Their service includes an auto-ship program, making the process easy for you to incorporate within your practice.

According to Nordent’s VP of sales, Tim Irwin, who has worked with thousands of practices all over the country, “The RDH survey really opened our eyes. It became apparent that for many offices, regular sharpening in the office just isn’t realistic. We hope that with our Relyant System, we can help clinicians work with instruments in better condition and realize all of the benefits of working with sharp instruments.”

This system is a win-win for all, freeing the hygienist to concentrate on patient care and periodontal therapy. Whatever system you choose — whether sharpening yourself or using a professional service, or a combination of both — commit yourself and your practice to using and maintaining only sharp instruments.

Implementing these strategies will enable you to achieve these common goals:

• Protect valuable office inventory; i.e., instruments and the doctor’s budget!
• Protect hygienists from repetitive wrist overuse
• Protect and support the doctor-hygiene professional relationship
• Protect your most valuable asset — your patients

Be sharp!

RDH Instrument Inventory Plan

• Take instrument inventory.
• Band (color-code) all hygiene instruments appropriately.
• Document acceptable level of sharpness and/or need for replacement.
• Bag and label appropriately.
• Research costs and services for maintenance and/or replacement.
• Prepare your proposal.

Author bio

Janet Hagerman, RDH, BS, is an international speaker, author, and consultant. A graduate of the Medical College of Georgia, she has practiced clinical dental hygiene for more than 30 years, and helped hundreds of dental practices in her roles as speaker, coach, and clinical director. Contact Janet at jhagerman@bellsouth.net. Visit her website at www.janethagerman.com.

Source: DentistryIQ  May 7, 2012