Dental mythbuster 17: Audit and improvement in primary dental services

Clinical audit and quality improvement form part of a service’s quality assurance and risk management.

Audit: why is it important?

Clinical audit reviews current practice and compares this to expected published standards. It:

• helps identify areas of practice that need improvement
• identifies and reinforces areas of good practice.

Ultimately, it is a tool to improve the quality and efficiency of patient care.

Quality improvement: why is it important?

Quality improvement is a systematic approach, using specific techniques to improve quality. It:

• allows real time change in current practice and provides opportunity to evaluate effect
• promotes teamwork and collaboration (Peer review)
• prevents poor practice.

What we look for on inspection

We expect providers to be involved in audit and/or quality improvement to:

• demonstrate good governance (Regulation 17)
• deliver care and treatment safely (Regulation 12), and
• ensure premises and equipment are clean and suitably maintained (Regulation 15).

You may also be required to conduct specific audits as part of your local contractual arrangements with NHS England.

Audits

Essential (must do) audits:

You must have effective quality assurance programmes covering:

• Infection prevention (decontamination) and control: complying with HTM01-05 (Decontamination in primary care dental practices) shows you have valid quality assurance systems in place. As a minimum, audit decontamination processes every six months, with an appropriate review dependent on audit outcomes. You could use the Department of Health dental toolkit. 
• X-rays: both IRR17 and IR(ME)R 2017 place a legal responsibility on practices to establish and maintain audits for dental radiology. There are details of how to carry out the audit under section 5.4.2 of “Guidance Notes for Dental Practitioners on the Safe Use of X-ray Equipment” endorsed by the College of General Dentistry (CGDent).
• Accessibility: All organisations providing services to the public must audit their facilities and ensure they comply with the Equality Act 2010.

Desirable (should do) audits or improvement projects:

• antimicrobial prescribing
• clinical record keeping
• other audit topics suitable for your practice.

Peer review

The Regulation of Dental Services Programme Board (RDSPB) recommend peer review as one way of maintaining good practice and preventing poor practice from emerging.  We consider peer review to be one of the hallmarks of a well led practice. Toolkits you could use, for example, are:

• Health Education West Midlands Peer Group Toolkit 2015
• South Staffordshire Local Dental Committee dental peer review group toolkit.