Medical errors are a huge problem throughout the healthcare industry, where, according to research cited by Yale, they are the third leading cause of death. While adverse incidents can occur in any branch of medicine, many patients are surprised to learn how common they are in the dentistry field. The National Practitioner Data Bank reveals that, between 1990 and 2020, over 32,000 adverse action reports were filed. Between 2010 and 2019, there were consistently between 1,400 and 1,500 such reports per year.
According to a peer-reviewed publication from Richard Nagelberg, DDS, the most common concerns include (in no particular order) medication errors, improper maintenance of equipment, improper diagnosis, and lack of follow-up care.
If these mistakes are the result of negligence (another word for failing to meet the standard of care), dental office employees may be found liable to harmed patients and their families. Even if legal issues never arise, these concerns affect patient safety. Therein lies the value of the dental office incident report — an essential document that we explain in detail below.
What Is the Purpose of an Incident Report?
Incident reports are intended to provide a detailed record of events during adverse patient incidents that occur on premises. These include any events that cause the patient physical harm. While some may specifically involve dental equipment and procedures, incident reporting may also follow events such as slip and fall accidents or even practice-acquired infections.
Preferably completed within 24 hours of an adverse event, dental incident reports serve a variety of functions, such as the following:
Incident reports provide insight into potential hazards at dental offices. By increasing awareness of such risks, these reports decrease the likelihood of them being repeated in the future. Should similar incidents occur on multiple occasions, detailed reporting will make it easier to observe a pattern.
Once patterns are identified, a root-cause analysis can take place. According to the Safety Net Dental Clinic Manual, the goal of this is to "[look] not only at the activities that immediately led up to the incident but also at the systems and procedures in place surrounding the incident." The National Network for Oral Health Access (NNOHA) adds that the lessons learned from observing incident reports "become part of future risk management activities."
Patient Safety and Satisfaction
Incident reports indicate what quality of care patients are receiving — and where improvements are needed. Certified Dental Consultant Belle DuCharme, RDA, CDPMA, CDC, highlights the importance of "[verifying] that each patient receives the attention and extra care to feel safe and secure."
Ultimately, incident reports play into a comprehensive strategy aimed at "providing a standard of care for [keeping] everyone safe." This, in turn, improves patient confidence, which is key to both attracting and retaining patients in a competitive industry.
What Kind of Incidents Require Reports?
As a general rule, incident reports should be completed in accordance with state requirements and industry standards. First, however, it's important to understand what constitutes a reportable incident. This varies somewhat based on the state in which the practice is located.
In its guidance on liability protection, the Safety Net Dental Clinic Manual explains that reportable incidents occur when patients are threatened or actively harmed in events that take place while they are on the dental office's premises. The designation of "reportable" also applies to "incidents that are inconsistent with the routine care of a particular patient or routine operation of the clinic."
Examples of reportable incidents referenced in a study from the Journal of the American Dental Association include:
- Errors with administering medications, including anesthesia
- Falls from chairs or equipment, or fainting Patient struck by tools or equipment
- Patient trips over hoses or tubing
- Excessive bleeding after soft tissue grafting
- Ingested fluoride
- Burns from dental lasers
What Should an Incident Report Include?
Carefully drafted incident reports should indicate who was involved, where the event took place, and how it transpired. They typically include the following components:
- The date and time of the incident.
- Where the incident occurred. For a system of clinics, this includes the address of the specific practice in which the event transpired. This section may also dive into specifics, listing, for example, the procedure room, supply room, or lab as the site of the event.
- The names of the patients who were involved in the event. For example, a patient who slipped and fell may be included, as could a patient harmed by defective dental equipment.
- The names of witnesses who were present during the incident. This section can also include the name of the employee involved in the incident.
- A chronological description of the incident. As the Safety Net Dental Clinic Manual points out, this includes a "brief, objective description of the facts," free of any "judgment as to the cause of the event."
- Injuries that resulted from the event. This section may also describe the patient's disposition prior to, during, and after the incident.
- The names of the dentist or any other supervisors who were notified of the incident.
Recommendations to Prevent Future Incidents
In addition to the details outlined above, each incident report can include or be used to make recommendations for preventing similar events in the future. This begins, as the Safety Net Dental Clinic Manual explains, with "assessing conformance to required standards of practice and care."
How Do You Write an Incident Report?
In some ways, writing an incident report reflects other dental office recordkeeping practices. For example: regardless of the contents of the document or the situation it describes, each report is written as promptly as possible. Even if the document cannot be completed right away, it's important to take notes. Otherwise, details are quickly forgotten.
A detail-oriented document is essential, as information that seems insignificant at the time can make all the difference in a contentious malpractice case. For example, instead of writing that "the patient fell and injured his leg," note that "the patient slipped on a puddle in the waiting room and fractured his tibia."
Experts at the American Dental Association (ADA) explain that "in the case of a malpractice claim, the record could appear in a court case and a judge and jury could read your notes." As such, it's important to focus on facts that relate to the patient's care. When determining what to include, the ADA recommends "[imagining] the record magnified and displayed in a courtroom."
Other takeaways are relevant for all types of dental office reporting:
- Use quotes from witnesses, when available and applicable; include witnesses’ contact information.
- Double-check for correct spelling and punctuation.
- Follow guidelines established by the clinic and, when relevant, the state board.
Despite the similarities between incident reports and general dental records, the Safety Net Dental Clinic Manual advises that incident reports not be "reflected...[or] placed in the medical record." After all, the incident report constitutes an administrative document rather than a medical record.
Who Should Complete an Incident Report?
An incident report typically is completed by the person most familiar with the incident, usually because he or she witnessed or discovered it. In many situations, this is a dentist or dental hygienist. The Safety Net Dental Clinic Manual, however, advises that all professionals — regardless of level — be familiar with reporting procedures.
Once completed, the document usually is submitted to the reporter's supervisor, who can investigate the situation and offer recommendations for both resolving the problem and preventing it in the future.
Where Should a Dentist Submit an Incident Report?
Since the purpose of the incident report is to chronicle the specifics of what happened while the details are fresh in your mind, the majority of reports will land with the dental office manager to safely store. This way, if a liability claim is filed against the practice, you will have ready access to the detailed notes you took at the time.
NNOHA adds that if a staff member was injured on the job, a copy of the report should also go to HR or office manager who should file a L&I (Labor & Industries) form.
Examples of Dental Office Incident Reports
Now that you're more familiar with dental office incident reports, it's time to see them in action. Templates and examples provide valuable insight into how reporting works. Below, we've compiled helpful resources to illustrate the reporting process.
NNOHA provides access to a helpful template from Seattle-based dental practice Neighborcare Health. This resource includes detailed instructions for reporting incidents. It explains that "[a]lthough you may not have sufficient information to initially answer all questions, it is important that the form be completed as fully as possible at the time of the accident."
Following this easy-to-understand instructions page, the form offers prompts that help employees describe adverse events. Questions include:
- What happened?
- What did I do?
The document also lists several examples of injuries patients may have sustained, as well as details about location, treatments, and extenuating circumstances. Finally, the document ends with safety investigation guidance for the supervisor. This section encourages supervisors to reflect on what caused each incident and how corrective action can be taken.
Ohio State University College of Dentistry
This template from the Ohio State University College of Dentistry begins by explaining why incident reporting is so important: it informs "facility administrators of incidents and allow[s] for the risk management team to consider changes that might prevent similar incidents in the future."
The document clearly explains reporting procedures, including the need to immediately contact supervisors and seek medical treatment. Next, the report continues with contact information, designation of the incident's category, and details about the body parts affected by the event.
Reporters are asked to describe not only the incidents but also applicable equipment and safety techniques. If relevant, this may be accompanied by details on body fluid exposure or sharps.
New Jersey Board of Dentistry
The New Jersey Board of Dentistry mandates that reports be submitted for "any incident occurring in a dental office, clinic or any other dental facility after dental treatment has been initiated that requires the removal of a patient to a hospital for observation or treatment." The Board provides a specific form for this purpose. This document includes spaces for entering the following details:
- Patient information, including relevant medical history.
- Dental procedure and its duration.
- Drugs administered before the incident occurred.
- A description of the incident, which can be attached as a separate document.
- Details about follow-up care, including any visits to the hospital.
Effective risk management means assuming that incidents will occur in dental offices from time to time — and planning accordingly. Detailed dental office incident reports can limit confusion following adverse events, thereby protecting both dental professionals and the patients they serve. A solid reporting system is a must-have for every practice — and the sooner it's implemented, the better.