Doctors

Quality Indicators
Definition of an indicator – A statistical measure of the performance of functions, systems or
processes overtime.
Incidence of Needle Stick injuries - Needle stick injury is a penetrating stab wound from a
needle (or other sharp object) that may result in exposure to blood or other body fluids. Needle
stick injuries are wounds caused by needles that accidentally puncture the skin. Needle stick
injuries are a hazard for people who work with hypodermic syringes and other needle
equipment. These injuries can occur at any time when people use, disassemble, or dispose of
needles. When not disposed of properly, needles can become concealed in linen or garbage and
injure other workers who encounter them unexpectedly. Parenteral exposure means injury due
to any sharp. All incidences of needle stick injuries should be assessed on a case by case basis.
Analyze needle stick and other sharps related injuries in the workplace to identify hazards and
injury trends. Data from injury reporting should be compiled and assessed to identify, 1. Where,
how, with what devices, and when injuries are occurring and 2. The groups of health care
workers being injured.
Incidence of blood / body fluid exposures - An exposure is when blood, blood components or
other potentially infectious materials come in contact with a staffs eyes, mucous membranes,
non-intact skin or mouth. All exposures to blood/body fluids should be assessed on a case by
case basis.
Adverse reactions to lignocaine - Report serious adverse reactions. A reaction is serious when
the patient outcome is death, life threatening (real risk of dying), hospitalization (initial or
prolonged), disability (significant, persistent & permanent), required intervention to prevent
permanent impairment & damage.

Managerial Quality Indicators:

• Incidents (Eg. Patient fall from dental chair, etc)
• Percentage of near misses
• Number of sentinel events reported, collected and analyzed within the defined time
frame
• Employee satisfaction rate
• Percentage of employees provided Pre-exposure prophylaxis
• Percentage of Medical records having incomplete and/or improper consent
• No. of Stock outs including emergency drugs
• Percentage of Re-do / Repeat lab work
• Percentage of Corrections / Alterations of lab work

Clinical Quality Indicators:

• Incidence of Needle Stick injuries
 • Incidence of blood / body fluid exposures
• Adverse reactions to lignocaine
• Extraction site Infection rate
• Surgical site Infection rate
• Root canal failure rate
• Implant failure rate
• Incidence of Dry Sockets
• Instrument separation in Endodontics

Handling Medical Emergencies in Dental Practice:

Medical Emergency Kit (Emergency medicines, equipments & infographics)

Medical Emergency conditions:

• Adrenal Crisis
• Anaphylaxis
• Asthma
• Cardiac Emergencies (Angina / MI)
• Epileptic Siezures
• Hypoglycemia
• Stroke
• Syncope
• Choking

Basic Life Support with CPR:

Cardiopulmonary resuscitation (CPR) is a first aid technique that can
be used if someone is not breathing properly or if their heart has
stopped.

Chest compressions and rescue breaths keep blood and oxygen circulating in the body.

SAFETY
Assessment of the situation to determine the reason for collapse
of the patient and if considered safe move to assess the patient
to determine level of responsiveness
SHAKE
Patient gently by the shoulders in an attempt to rouse the patient

SHOUT
If patient unresponsive
SEND
First responder can ask someone to call for medical help.

Medical help shall be soughted by contacting nearest

emergency/ E&A dept of a medical facility.

Victim should be positioned supine appropriately

CAB (Circulation Airway Breathing) assessment should be performed and CPR to be
started according to AHA protocols.
The patient to be placed on the flat surface with the help of the second responder as
soon as he/she comes in the site of incident.

Protocol

Technique
CPR comprises the following 3 steps, performed in order:

1. Chest compressions
2. Airway
3. Breathing

Positioning for CPR is as follows:

CPR is most easily and effectively performed by laying the patient supine on a relatively
hard surface, which allows effective compression of the sternum Delivery of CPR on a
mattress or other soft material is generally less effective
The person giving compressions should be positioned high enough above the patient to
achieve sufficient leverage, so that he or she can use body weight to adequately
compress the chest

Unconscious Adult

CPR is initiated as follows:

Give 30 chest compressions

Perform the head-tilt chin-lift maneuver to open the airway and determine if the patient
is breathing
Chest Compressions
The provider should do the following:
Place the heel of one hand on the patient’s sternum and the other hand on top of the
first, fingers interlaced
Extend the elbows and the provider leans directly over the patient
Press down, compressing the chest at least 2 inches
Release the chest and allow it to recoil completely
The compression depth for adults should be at least 2 inches (instead of up to 2 inches,
as in the past)
The compression rate should be at least 100/min
The key phrase for chest compression is, “Push hard and fast”
Untrained bystanders should perform chest compression–only CPR
After 30 compressions, 2 breaths are given; however, an intubated patient
should receive continuous compressions while ventilations are given 8-10 times per
minute
This entire process is repeated until a pulse returns or the patient is transferred to
definitive care
To prevent provider fatigue or injury, new providers should intervene every 2-3 minutes
(ie, providers should swap out, giving the chest compressor a rest while another rescuer
continues CPR)

Ventilation:
If the patient is not breathing, 2 ventilations are given via the Ambu bag and mask.
After 30 chest compression, give 2 breaths (the 30:2 cycle of CPR)
Give each breath for approximately 1 second with enough force to make the patient’s
chest rise
Failure to observe chest rise indicates an inadequate mouth seal or airway occlusion
After giving the 2 breaths, resume the CPR cycle

Children
Tap the child and use his or her name if you know it, asking “Are you okay?”

If a child can respond to you, is in severe distress but breathing, do not move her, but
activate the emergency response system or getting someone else to call.
If the child is breathing and you are alone, you can leave briefly to make the call.
If the child is unresponsive, you need to see if she is breathing. If she is breathing, you
do not do CPR.

Children who are having trouble breathing may often find the best position to sit in; do
not move a child in this situation. If the child is breathing regularly, turn her onto her
side.
If he is not breathing, or taking irregular, infrequent gasps, you must begin CPR. The
first step is chest compressions, compressing the breastbone.
Infants and children both need 30 quick compressions. To do this:

Push fast – the rate should be 100 a minute.

Push hard – enough to depress the chest approximately 1 ½ inches in infants and 2
inches in children.
Let the chest rise up again after each compression.
If possible, do this with the child on a firm surface.

Indications and contraindications

Indications

CPR should be performed immediately on any person who has become unconscious
and is found to be pulseless.

Contraindications

The only absolute contraindication to CPR is a do-not-resuscitate (DNR) order or other

advanced directive indicating a person’s desire to not be resuscitated in the event of
cardiac arrest. A relative contraindication to performing CPR is if a clinician justifiably
feels that the intervention would be medically futile.

Complications
Complications of CPR include the following:
Fractures of ribs or the sternum from chest compression (widely considered uncommon)
Gastric insufflation from artificial respiration using noninvasive ventilation methods
(eg, mouth- to-mouth this can lead to vomiting, with further airway compromise or
aspiration; insertion of an invasive airway prevents this problem

Post CPR

The patient will be referred to the nearest hospital. Someone from DHSP shall
accompany the patient.