Dental Practice Risk Management Essentials: Article 5

Strategies to Help Minimize Adverse Events
By Emilleigh Eckert, Manager of Legal and Risk Management

We are all human and errors occasionally happen even when proper protocols are followed. Take for example a new patient, who’s never been under anesthesia, has an adverse reaction to anesthesia during a procedure. Neither you nor the patient could have known this would happen. Then there are times when adverse events are in fact related to human error. Human errors happen in both health care and dentistry, so you shouldn’t focus on trying to be perfect, but to know the tools on how to manage these unfortunate events. One of the best and easiest tools as a dental professional is to always be upfront and honest with patients about any procedural error or adverse event during treatment. Your honesty upfront will mitigate the effects of an adverse event.

The number of malpractice claims brought against dentists increases every year. The residual effects of these claims include:

  1. Increased costs of malpractice insurance
  2. Costs passed on to patients through increased fees
  3. Dentist’s concerns to practice dentistry from a defensive standpoint

Protecting both your patients and practice requires the upfront identification and management of risk. Steps to manage your risk include identifying, evaluating, eliminating, reducing, and transferring risk. Safety inspections and audits of clinic activities are proactive ways to identify problem areas or trends.

Always Be Upfront & Honest
An astounding 95% of patient complaints result from poor or no communication from the doctor – whether from treatment or adverse events. Patient communication is crucial and strategic when dealing with unfortunate or unexpected adverse events. It’s important to remember that just because an adverse event occurs, it does not mean you deviated from the Standard of Care or were negligent in any way. Things can happen while performing dental procedures that might produce unexpected results, even if all precautions were taken.

That’s why it’s important to always be UPFRONT & HONEST with your patient about any adverse event or unexpected outcome(s) when they happen. Even a professional and highly experienced dentist cannot foresee every possible adverse event and cannot control every aspect of treatment. Hence, why there is the Informed Consent Process. With immediate and truthful disclosure of any adverse event, there’s less likelihood of a patient complaint or them filing malpractice claim or lawsuit.

Take for example:

  1. While putting on a crown, a bur or your hand piece cuts the inside of a patient’s cheek. Is it life threatening? No. Could they notice? Possibly yes or no. You tell the patient what happened and advise them how to properly care for the inadvertent cut toprevent infection. You also tell them to call the office if they experience any pain or swelling in the area. The cut heals and there are no further problems. By being upfront and honest with the patient, you have avoided a crisis. The patient returns for their next scheduled visit without hesitation and continues to recommend your practice to their friends & family.
  2. Same procedure with same adverse injury. You decide the cut is nominal and patient won’t notice. Six days later the patient goes to ER because their mouth is swollen shut with excruciating pain. They couldn’t get a hold of you because you’re closed onSaturdays. ER doctor tells patient there’s a laceration on the cheek (bigger than you thought) with a subsequent infection. How do you think the patient feels? They probably feel betrayed or deceived because they weren’t told about the cut during the procedure. The patient could loose trust and may hesitate returning to the practice. They’re also less likely to recommend your practice to friends and family. Bottom line – always tell patients of any adverse events, unexpected outcomes or problems that occur during treatment.

Documentation is Crucial
Always document patient conversations about any adverse event. Also, be sure to include post treatment instructions provided, specific details of what you did to address the event and any additional details about the complication. Complete and accurate chart documentation helps support you should a patient file a malpractice claim. As with most things in life, honesty is always the best policy!


Disclaimer: This publication is for educational purposes only. It is not legal or dental advice. Benevis or its staff make no representations as to its correctness or completeness and accepts no liability for any injury or damage that may arise from its use. Specific legal or dental questions should be referred to a competent attorney or dental professional.