Dental Services

Project

Lead:  Katherine Bilcliffe, Dental Matron

What was the problem?

Creating shift rotas for community dental services was a manual process which was extremely time consuming due to the volume of clinical locations and staff and often adjustments were needed at short notice.

Aim

To reduce the time spent on creating and adjusting  programmes, as well improving their automation to, accuracy, consistency and analytical capability for the Community Dental Nursing Team by December 2025.

 
What did we do?

• Created a excel workbook with automated capabilities.
• Review implementation over the next 6 months and research further ways to automate programme.
• Released as pilot in Birmingham.
• Collected feedback from Dental Nurses and Clinicians.
• Streamlining annual leave request processes could provide report to be pulled to further support the correct tracking of annual leave approval in line with service activity.

What were the benefits for patients and staff? 

• Time saved.
• Accuracy levels improved.

Measures used

• 5 W's and 2H's (who, what, why, where, when, how, how many) were used to identify the root causes of the issues.
• Fishbone diagrams were created to identify cause and effects of the issues.
• Change ideas were ranked and prioritised.
• Data was collected and displayed, analysed using pareto charts.
• Multiple PDSA (plan, do, study, act) cycles were planned and used.

Qi tools used

• Datix Reports.
• Audits.
• Feedback.

Project

Clinical Illustrations and Orthodontics essential care project.

Leads: Katie Owen, Interim Clinical Illustration Manager; Malaaika Al-Koky, Specialist Registrar ST1

What was the problem?

Feedback was received from patients around various topics such as unsure of what to expect with the clinical photographs that were due to be taken, neurodiverse and anxious patients unsure what to expect, a patient was upset around removal of her headscarf and where the photos would be seen and also where the clinical photography department actually was.

Aim

By August 2024, to ensure all patients are fully aware of what to expect when clinical photographs are taken.

What did we do?

To create two improvements covering the following:

• Patient engagement (new leaflet) so the patient is aware of what to expect from their clinical photography appointment throughout their treatment. Improving patient experience.
• Inclusivity (photography contact sheet): the patient is shown the requested clinical photographs required for their treatment. Options for those with head coverings are available for the facial views. Images will be available on the orthodontic department in each bay to improve the consent process.

Implementation of improvements:

• A leaflet was produced and reviewed at the patient engagement forum which raised awareness to patients of what to expect in their clinical photography appointment.
• This will be provided to all Orthodontic patients at their initial appointment (new patient clinic).

What are the benefits for patients and staff)?

• Less confusion for patients on what to expect at appointments.
• Patients having full understanding of procedures being undertaken and the requirements needed in advance of appointments.
• Time saved for staff not having to answer additional queries that are now covered in new leaflets.

Measures used

• Patient feedback.

Qi tools used

• Plan, Do, Study, Act (PDSA) Cycle.
• Process Mapping.

Project

Safe sedation practice (SAAD)

Leads: Laura Warrilow, Specialist Paediatric Dentistry; Ayman Dhanji, Specialist Special Care Dentistry.

What was the problem?

There are a number of individual audits and projects surrounding sedation and this is an ideal way to centralise this information and ensure we are looking at all elements of quality and safety. It is an opportunity for us to highlight the many areas of sedation we are already doing well and our previous good work e.g. the sedation template. It’s also a good way to look for areas we might be able to improve, for example how we record sedation training. Once completed, this will provide a summary document which could act as evidence of good practice should it ever be needed for the CQC.

Aim

The aim of the project was to ensure each of the community clinics where sedation is carried is fit for purpose and in line with the criteria from the SAAD safe sedation practice scheme to ensure that the sedation carried out is in line with the defined principles for safe sedation practice, as outlined by SAAD.

What did we do?

• The aim is also to start off by doing this in CDS and once a process that works has been established, the aim is to then look to evaluate sedation in Paediatrics BDH.
• The project will be quite broad, completed for both Paediatrics and Special care across all CDS sites delivering sedation, meaning 13 clinics in total. Some aspects can be looked at on an overall basis, for example policy, others will be site specific, for instance equipment available.

Results were very positive confirming that a safe and high-quality sedation service is being run. Working across a wide range of sites across CDS and a variety of setting, for example clinics, Dental Hospital and tertiary hospitals and it is positive to see that standards have been maintained throughout. SAAD document suggests results are categorised and it has been identified that there is nothing that would count as a major deviation requiring immediate action. An excellent standard of observed patient care was documented.

Next steps:

• Review induction for staff as it is currently variable throughout CDS and staff groups. This includes developing a plan to have formalised sedation induction checklist for Paediatrics, Special Care and Nursing.
• To ensure there are copies of sedation qualification retained and the sedation policy read.
• There is currently no formalised process for monitoring competency within existing members of staff. A proposal is to introduce a “Sedation Passport” to be integrated into the “Radiology Passport.” All staff will be required to complete initially then updated at appraisal which would include evidence of appropriate CPD and cases being recorded.
• It was identified that there was a gap with easy read or paediatrics patient specific leaflet. These are in development.
• There were some issues with record keeping identified with minor issues primarily at assessment stage. The Paediatrics team are amending their template to reflect this and Special Care supporting clinicians to improve.
• Identified that staff due some medical gas training e.g. handling cylinders safely and look at long term how often needs to be repeated.
• Implement changes and mechanisms to maintain them going forward.
• Share project and learning with dental division and support the roll out of evaluation beyond CDS.

What are the benefits for patients and staff)?

• Ensuring good practice for Safe Sedation (SAAD).

Measures used

• Patient feedback.
• Staff feedback.
• Review of small sample of clinical records.
• Observation.

Qi tools used

• Plan, Do, Study, Act (PDSA) Cycle.
• Audit.
• Feedback.

Project

Preparation is key.

Leads: Fionnuala Loy.

What was the problem?

A service evaluation in 2016 showed that the majority of Dental paediatric patients are severely anxious. There had been many changes and a global pandemic which may have impacted on the dental anxiety levels of our paediatric population. There was a need to reflect on our current practice and make improvements which highlight there were no online preparatory video information on dental assessments specific to BDH is currently available.

Leaflets on dental assessments are available (hard copy only) and were designed for children with learning needs and autism. These leaflets are not routinely being sent with new appointment letters.

Aim

To reduce pre appointment anxiety in dental assessments for children with learning needs and autism by August 2025.

What did we do?

First PDSA cycle was to:

• Assess the anxiety level of patients attending for dental assessments at the Birmingham Dental Hospital (BDH).
• To gain feedback from patients about current preparatory resources for dental treatments at Birmingham Dental Hospital (BDH).
• To ascertain if patients feel that a preparatory video on dental assessments in the BDH would be helpful before their treatment appointment.

First PDSA cycle showed over 40% of new patients coming to the dental hospital for a paediatric dental assessment are anxious and over 50% of these patients did not know what to expect. The majority of patients from this survey would like preparatory information and video information is preferred to leaflets.

The team liaised with clinical illustration re: video for new patient appointment (to include radiology visit as per feedback).

 
Dental’s internet pages have the 2 videos to support our paediatric patients attending their Dental appointment under ‘Videos for Patients Visiting our Services’.

PDSA Cycle 2:

• To gain service user feedback on how helpful the questionnaire has been to prepare paediatric patients attending new patient assessments.
• To find out if the QR code and link for the survey were easy to find on the new patient letters.

What are the benefits for patients and staff)?

• Reduced pre-appointment anxiety in patients.

Measures used

• Patient feedback.
• Staff feedback.

Qi tools used

• Plan, Do, Study, Act (PDSA) Cycle.
• Feedback.

Project

Making every contact count: Orthodontics

Leads: Nabeela Caratela, Dental Core Trainee.

What was the problem?

Missed opportunities for signposting and recommending brief advice for a number of behavioural risk factors which can support patients towards improving their oral and general health.

Aim

By August 2025 to increase awareness and knowledge amongst the Orthodontic Team of the MECC (making every contact count) national initiative.

What did we do?

Results of 1st QIP:

• Limited awareness and training of the MECC initiative. Limited knowledge of relevant services and resources to signpost patients to. The main barriers to giving patients advice were lack of time and knowledge, feeling uncomfortable with sensitive conversations and lack of patient compliance. Due to time pressures, signposting may be more feasible than giving patients specific advice.

Actions following 1st cycle:

• Delivery of formal training and resources at the West Midlands Consultant Orthodontic Group Meeting and Orthodontic Nurses and Therapist Meeting, July 2024.
• Presentation of findings at WMCOG and Nurses meeting.
• Peer-reviewed CPD publication: Dental Nursing Journal.
• Post-intervention survey to quantify the impact of the action plan.

Results of 2nd cycle:

• Overall, knowledge and awareness of MECC amongst the Orthodontic Team improved following completion of this project. The Orthodontic Team is in an ideal position to provide the recommended very brief advice to patients regarding behavioural risk factors. Provision of very brief advice and signposting appropriately should take seconds to a few minutes and should not impact existing time constraints.

What are the benefits for patients and staff)?

• Patients are signposted appropriately regarding behavioural risk factors during existing appointments or contacts.
• No need for additional appointments for signposting.
• Provision of brief advice and signposting is done in existing appointments and should not impact time constraints.

Measures used

• Prospective, 2 cycle.
• Bespoke prospective questionnaire.
• 10 questions to assess knowledge, attitudes, current implementation and barriers surrounding ‘MECC’ amongst the Orthodontic Team.
• The questionnaire was disseminated at the West Midlands Consultant Orthodontic Group Meeting via paper forms and for those not in attendance, via Google Forms in February 2024 (1st QIP cycle).
• A questionnaire to evaluate the impact of the interventions was distributed via paper forms at the West Midlands Consultant Orthodontic Group Meeting and Dental Nurses Meeting in July 2024 (2nd QIP cycle).

Qi tools used

• Plan, Do, Study, Act (PDSA) Cycle.

Project

Amazing Amelia.

Leads: Stacey Quinton, Specialised Oral Health Improvement Practitioner Team Lead and the Oral Health Improvement Team.

What was the problem?

The Oral Health Improvement team are a newly established team delivering evidence-based programmes throughout Birmingham and the Black Country to address oral health inequalities for our services users that have the greatest need.

Aim

Create a booklet to address oral health inequalities for service users with the greatest need throughout Birmingham and the Black Country.

What did we do?

• Created an Amazing Amelia story booklet to give to service users to support oral heath inequalities.
• A leaflet was also developed aimed at adults with Learning difficulties called ‘My teeth and Gums with a similar idea.

What are the benefits for patients and staff)?

• A notable achievement which has been greatly accepted and welcomed by colleagues and service users is the production of Amazing Amelia story booklet.
• They have worked extremely hard to establish links within their local communities and have played a pivotal role in making positive changes to ensure success.
• This has been presented as a quality improvement project to various committees in the Division and wider in the Trust including Improving Together forum highlighting how children and their families learn about how to look after their teeth.
• The resource is currently undergoing a Makaton review.

Measures used

• Feedback from service users and carers.

Qi tools used

• Plan, Do, Study, Act (PDSA) Cycle.
• Qi Huddle meetings.

Project

Oral surgery directions.

Leads: Cherelle McCalla, Dental Nurse.

What was the problem?

A member of staff felt that there could be improvements made within the area due to ‘patients getting lost on their way out (of clinic) and to x-ray,’ so set out to find a solution and sought the opinions and thoughts of the nursing team. 

Aim

By August 2025, to provide signage and floor stickers showing directions from dental clinics to x-ray.

What did we do?

This was raised during a QI huddle as a new improvement idea which was then discussed as a team during the Qi huddle. As part of these discussions, it was suggested that floor sticker and a sign at the end of the department corridor may be a small but effective way of solving this problem.

After working closely with Clinical Illustration to bring the idea to life and liaising with Senior Management to seek approval for the Quality Improvement idea, the change has now been successfully introduced, and floor stickers and sign have been added showing the way into the Oral Surgery Department.

What are the benefits for patients and staff)?

• Less confusion for patients in finding x-ray and back to clinic.
• Time saved for patients in finding x-ray.
• Time saved for staff in not giving directions.

Measures used

• Patient feedback.
• Staff feedback.

Qi tools used

• Plan, Do, Study, Act (PDSA) Cycle.
• Qi Huddle.