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As a Registered Dental Hygienist and Educational Consultant, I am dedicated to working with many practices in achieving the highest level of care for their patients. I establish evidence-based periodontal protocols with hygienists and doctors that are client-centric based on their patient's risk assessment. Nothing is more rewarding for me then to put on my lab coat while sitting next to a hygienist and bringing clarity to many of the basics we've all learned in school like instrumentation techniques and assessment/documentation. Once we review the basics, the next step is to help empower the hygienist to optimize their skill set and bring them to the highest level. It's priceless when a doctor or hygienist releases the flurry of ambiguity and succumbs to the "light bulb moment" in grasping the concept of I.D.E.A.: Identifying, Documenting, Explaining (communicating) and taking Action with their patients.
Let's examine how consistent chart/case audits, using I.D.E.A., instrument organization, selection and maintenance will assist you and your team in mastering proficiency and efficiency.
Chart Audit
Performing a chart audit can uncover so much information about a patient. The most important time to perform a chart audit is before you see your patients, generally at the morning huddle or before/after lunch the prior day of their appointment. A comprehensive risk assessment for the whole-patient approach begins at the medical history. I have a complete checklist I provide for my practices to utilize when looking for their patients' contributing risk factors. The focus here is caries and periodontal diseases, including parafunctional habits. If one or more contributing factors are found, further investigation and follow-up are necessary.
Chart audits tell the story of your patient and help you map out the course of your treatment based on their previous history – particularly from the previous Full Mouth Probing (FMP) history. I often find three major concerns when performing a chart audit in many practices:
- Incomplete (or no evidence of) periodontal documentation and/or
- A tremendous amount of patients treated as a "prophy" that exhibit pockets in excess of 4mm with bleeding on probing (or written on the treatment sheet as moderate bleeding)
- Patients who exhibit active disease but are placed on a "watch and see" status, time after time in hope that these patients will improve through their self-care oral hygiene improvement regimen.
To address these concerns, an established protocol consisting of a comprehensive total-health, risk and periodontal assessment is paramount. In aligning your practice to follow the I.D.E.A. principles, you are Identifying any deviation from health. The doctor and hygienist can work together to provide a diagnosis that includes a comprehensive Documentation. Explaining to your patients using the "See-Know-Do" approach – a concept I learned from fellow colleague Kirsten Jarvi, RDH, BS is fundamental:
"Mrs. Jones, this is what I see…you have gum disease which is an infection…"
"Mrs. Jones, we know through science that we cannot allow this infection to be left alone…"
"Mrs. Jones, this is what we need to do to treat the infection which includes periodontal debridement, placement of a localized antibiotic, etc."
The last factor of the I.D.E.A. plan is to take Action. In order for you to be effective in your treatment approach and efficient with your time, the foundation to the therapy you are providing needs to incorporate optimal, organized instrument selection to bring you to your A-Game.
Instrument Organization
What I often observe when I visit most practices are hygienists scrambling and running to find a particular instrument while the instruments are strewn all over the office. More time is wasted on looking for the "right" instrument, yielding with an enigma for dental practice owners who must deal with wasted time and productivity associated with countless hunting and drawer searching while running behind schedule. I constantly watch the shuffle of instruments going from the treatment room to the sterilization room; all sorts of potential hazards and injuries that arise with handling, cleaning, and bagging of instruments.
Fortunately, Hu-Friedy created the Instrument Management System (IMSTM) to organize, standardize, protect and promote better time-management in your practice. Instruments can be easily organized by "ringing" or banding every instrument and placing them in the IMSTM cassette in a diagonal pattern.
You can immediately identify if an instrument is missing and where to put the instrument after it is used. I recommend placing instruments used first (i.e. mirror, probe, explorer) in order beginning closest to the clinician, then arrange your scalers, curettes, and additional instruments to follow suit.
Instrument Selection
Whether I am practicing or consulting, my personal choice in keeping my clients or me on our A-Game is to utilize a broad combination of instruments. This includes Gracey curettes in addition to scalers, Micro Mini Five Gracey curettes, and power scalers. I use the After Five® Gracey line to provide optimal access to difficult areas. To improve efficiency in the posterior areas, I use the 11/14 and 12/13 during treatment. With one instrument, I can maneuver my way toward the mesial and distal surfaces in specific areas with effective finesse strokes. At this point, I switch to the other instrument to reach the other areas in the mouth. While there are over 400 curettes to choose from, I recommend tailoring your instrumentation choices based on the patient's needs and morphology. For best practices and optimal efficiency, keep additional supplies of styles and sizes within reach.
To reach the difficult to reach posterior teeth, the Gracey 17/18 curette offers accentuated shank angles and a long terminal shank to reach deep into the periodontal pocket, while the shank on the Gracey 15/16 curette bends similarly to the Gracey 13/14 with an offset blade to reach the mesial surfaces.
Instrument Maintenance
Hu-Friedy EverEdge® Technology provides longer intervals ordinarily used for sharpening, thus increasing a clinician's productivity and efficiency in the office. I truly believe one of the most significant benefits that the Hu-Friedy EverEdge® Technology provides for the clinician is improving the time necessary to remove subgingival deposits while decreasing risk for repetitive hand/wrist injuries. One idea to increase productivity is to empower the dental auxiliary team to maintain scalers and curettes with consistent sharpening results by investing in a Sidekick Sharpener. Even if hygienists need to maintain their scalers and curettes, the Sidekick Sharpener is quick and easy, small and cordless.
Bringing it all together!
Increasing proficiency and efficiency in a practice can be achieved through proactive auditing of your patient charts along with auditing your existing instrument armamentarium. Are your instruments sharp enough to remove deposits easily with little effort? Are your instruments staying sharp for long periods of time? Are they easily accessible when you need them? Do you have the right instrument to access difficult to reach areas easily? Are you handling and sterilizing your instruments safely without risk of injury? If you answered "no" to any of these questions, you should consider the time value of money spent on your instrument upkeep versus investing in high quality instrument systems that save time and money in the long run. Isn't your time better spent on the relationships you established with your patients?
About the Author
Dona Gabzdyl, RDH, BS, MBA is a practicing dental hygienist, educational consultant and president and owner of Strategic Practice Consultants, Inc. Dona is also a national corporate dental practice consultant with Practice Synergistics, Inc. that focuses on elevating organizational performance through core principles. Dona is a Thought Leader for Hu-Friedy and a key opinion leader speaking and writing on new dental products and technology, periodontal disease, remineralization, geriatrics, and communication. She specializes in optimizing hygiene productivity and efficiency - taking the guesswork out of insurance coding and treatment ambiguity. Dona is an active ADHA member and Illinois Dental Hygiene Association delegate, volunteers for the Northwest Community Healthcare Mobile Dental Clinic and was chosen in 2009 by the American Dental Hygienists' Association to receive the Hygienist Hero Award for her efforts, along with achieving the 2005 Elk Grove Township Community to Service Award. Dona lives in the Chicago Suburbs with her husband and three children.
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