COLLEGE OF
DENTURISTS OF ONTARIO

Regulating the profession of Denturism since 1973

QUALITY ASSURANCE ASSESSMENTS

Quality Assurance Regulations - General O.Reg 206/94

PREPARING FOR ASSESSMENT

"Dear Denturist:
You have been selected for assessment..."

You have received a letter from the College of Denturists of Ontario notifying you that you have been selected for a Quality Assurance Assessment. This letter often prompts a number of questions, and the following section provides some answers:

How is the Assessor going to assess you? You work in a mixed array of clinical and non-clinical environments.

Most professional members work from their own clinic, complete with reception area, office, laboratory and operatory. There are exceptions though where individuals are working in association with dentist(s), nursing homes, patients' homes or a variety of environments. Does this exempt the professional member from being assessed at his/her principal location?
Absolutely not.

Where are you assessed?

The bulk of the assessment will be conducted in your principal location. If that means you spend most of your time in a dentist's office, the assessor will arrange to meet you at this location and will conduct their assessment of the facility while maintaining a low profile. There is no reason for the office to close or refrain from conducting a full slate of appointments. The assessor will meet with you for a few minutes at the beginning of the assessment and then again at the end of the assessment, and may ask for directions or for files in the interim.

How this will impact the facility owner?

The facility owner is obligated under the Regulated Health Professions Act, 1991, to make records and the facility that the Denturist uses in the course of his/her patient treatment available to the Quality Assurance Assessor for the purpose of review. If there are areas identified where remedial actions need to be taken, the owner will be required to address the assigned actions to bring the facility to standard. If the owner is not willing to allow the Quality Assurance Assessor access to the records and facility, his/her professional college will be notified and asked to intervene on behalf of the College of Denturists.

What if you practice in patients' homes?

Admittedly there are not many professional members who work solely in patients' homes, but if you do and are selected for assessment, the Assessor will arrange to meet you at your home, where he/she will review your patient records. You will be carrying your equipment to and from patient appointments in a medical bag, so the assessor will inspect this bag assuming it has been prepared to be taken with you to a patient's appointment. The Assessor will look for the method which ensures proper hygiene and asepsis, and will need to rule out the possibility of cross-contamination from one patient to the next.

In your home, the assessor will inspect the laboratory and the separate area designated for sterilization.

If you only conduct occasional appointments in a non-clinical treatment throughout the year, the Assessor will ask questions about the processes you follow and may wish to see how you would prepare your bag for a visit.

How does the Assessor discern which Practitioners work in non-clinical environments?

Assessment of Denturists providing Patient Appointments in a Non-Clinical Environment Questionnaire.

You will automatically receive this form with your letter notifying you that you have been selected for an Assessment. You are required to answer this questionnaire according to instructions, and return it by mail to your Assessor within 5 mailing days of your assessment appointment.

This questionnaire asks about the processes you follow in non-clinical environments. The questionnaire requires your signature and, on completion of the assessment, the Assessor will also sign the form. This form is then retained in your file at the College of Denturists of Ontario for reference.

Review the Quality Assurance Webpages
Self Evaluation to ensure that your self-evaluation form is complete and up-to-date
Infection Control, Leaving a Practice,
Patient Management, Practice Standards
to ensure that your record keeping, infection control, asepsis and hygiene and clinic premises are up to standard
Professional Ethics and Sexual Abuse to be aware of appropriate and professional behaviours

Your Certificate of Registration must be prominently displayed in your clinic!

It is a good idea to review this micro site periodically, whether you are preparing for an assessment or personally reviewing your practice. If you have any questions in advance of an assessment, please phone the College of Denturists of Ontario at 416.925.6331 ext. 224 or email jslabodkin@denturists-cdo.com.

The Office Visit

Members should plan their schedule to allow for two 30-minute meetings with their assessors - at the start of the appointment (for a verbal review) and the end of the assessment (for the assessor to summarize their findings for the member). At this time, the assessor will also give the member the opportunity to clarify any information and discuss concerns the member may have about the preliminary report.

Self-evaluation

Part of the assessment will be devoted to examining your self evaluation portfolio. 

All activities such as seminars, workshops, conferences/AGM, correspondence courses and practice management seminars should be recorded. Completing and maintaining the portfolio each year will monitor individual goals, accomplishments and potential weaknesses. (A minimum of 10 hours is recommended per year).

Record keeping activities

Use the Standard of Practice: Record Keeping to help identify opportunities for improvement with record keeping.

Clinical and Lab Inspection

Clinic and lab inspection begins the moment the Quality Assurance Assessor arrives at your parking lot (if you have one). Ease of parking and accessibility to the clinic is evaluated. Signs and certificates must be displayed properly. Cleanliness and evidence of instrument cleaning and sterilization are assessed. A small area in the operatory or lab area must be set aside and dedicated solely to instrument sterilization. All sterilized instruments and equipment must be stored in sealed containers in a manner to minimize cross-contamination. All equipment in operatory and lab must be in working condition.

On the assessment date, the regular clinic routine need not be interrupted. The Quality Assurance Assessor will work unobtrusively around patients and appointments.

Follow-up

Once the Assessor has completed the assessment, he/she will sent a report to the College of Denturists of Ontario. The Quality Assurance Committee will review the report, and a decision letter reflecting its findings will be sent to you along with a copy of the assessment report.   

The decision letter will also provide further direction and/or identify the need for follow-up action in instances where deficiencies are identified during the assessment. 

Contesting the Assessor's findings?

You have 15 days from the receipt of the remedial notification to state your position in a letter. This letter will be kept in your file and your position will be reviewed.

If there is a Complaint or Discipline Action filed against you will the Quality Assurance Assessment be referred to?
No. This is an internal process intended to maintain a minimum standard in the profession. In accordance with the Regulated Health Professionals Act, the results are confidential and may not be viewed by any other committee in the College of Denturists of Ontario.

Record keeping

As part of the Quality Assurance Assessment process, the Quality Assurance Assessor will review your record keeping procedures. The Assessor will ask to see a sample selection of your records.

You may find it beneficial to review the College's Standard of Practice: Record Keeping.

Why do I need to keep all of this information?

Consider your record keeping a snapshot of your patient. With accurate and complete records you are able to continue treatment regardless of the time lapsed between visits. Your records will indicate where treatment was required and your reasons for providing the treatment.

If you are required to report on your treatment of your patient, to another health professional, or if a complaint or claim is filed by your patient, your records will be called upon to support your reasoning. The better the documentation you maintain on each patient, the more proficiently you can move through this process. Conversely, if you do not have patient records to support your reasoning, the process will be slowed and your credibility may be called into question.

What if I do not have my own clinic, but work from a Dentist's office?

The facility owner is obligated under the Regulated Health Professions Act, 1991, to make records and the facility that the Denturist uses in the course of their patient treatment available to the Quality Assurance Assessor for the purpose of review. You will be required to make arrangements for the Assessor to have access to the facility and a sample of records relating to your patients.

The Quality Assurance Assessment of the facility is not lengthy and should not interfere with the regular operations of the facility.

What if I do not have my own clinic, but work from locations such as home visits and nursing homes?

If you are working remotely, it is expected that you will have an area of your residence dedicated as a professional office. This area will include a secure file cabinet for your records.

If you are strictly working from a computer (either desktop or laptop), the computer must have password security and be connected to a printing device, so that a copy of records can be made. In addition to this, a backup of the electronic files must be kept and stored in a separate location.

Record keeping - what is a secure environment?

A concern is raised when the Quality Assurance Assessor notes that your filing cabinet is not secure, and/or that your electronic files are not password protected. According to the Personal Health Information Protection Act standards, the filing cabinets should either have a lock on the cabinet, or should be in an area that can be locked. For example, if your filing cabinet is in the reception area, there should be a door separating this area that could be locked so that cleaning staff could not enter this area at night. This means someone in your office (you or a staff member) will be assigned with cleaning the area, independently of the cleaning staff.

Your computer needs to be configured so that the database, or file with patient records have restrictions on entry. Only people who require access to these records should be familiar with the password. It is recommended that you change the password regularly for additional security.

The computer screen must face away from the area where patients sit, so the patients cannot inadvertently view the screen. If, due to space restrictions, this is not possible, you should attach extensions onto your monitor which can be purchased at office supply stores.

TIPS ON PREPARING FOR THE ASSESSMENT

Refer to Patient Management for an outline of what the Quality Assurance Assessor will review at their visit to your office.

Forms - do I have all of the Forms the Quality Assurance Assessor will ask for?

The Quality Assurance Assessor will ask to see proof your Continuing Education activities. A minimum of ten (10) credit hours per year of personal attendance to professional development forums (such as Perfecting Your Practise), courses, seminars, lectures or intensive technical reading is deemed to be appropriate.

The Quality Assurance Assessor will also ask for a copy of your office Privacy Policy form and the Health Consent form.

When you are advised of a pending Quality Assurance Assessment, you will receive a questionnaire about practising in locations other than a clinical environment. Make sure you complete this form for presentation to the Assessor.

Storing supplies under the sink - why is this a problem?

Again, a concern is raised when the Quality Assurance Assessor notes that you store supplies, such as paper products, under your sink.

Because of the potential for moisture to accumulate and the opportunity then for mold to grow, it is recommended that supply products be stored in areas other than under the sink.

Logging autoclave test results - what is an acceptable process?

The Quality Assurance Assessor will ask to see your log of autoclave/chemiclave/dry heat sterilizer test results. Tests should be conducted monthly and the results recorded in a log.

Test Kits can be purchased from your dental supplier. Each kit typically comes with 12 control strips, 24 test strips and 12 return envelopes. The typical process for each test is to place two (2) test strips in the sterilizer at a different location. Following the sterilization cycle, the strips are placed into a return envelope provided by the supplier and sent to the Laboratory for testing.

Biological indicator test strips are prepared from suspensions of Bacillus atrophaeus and Geobacillus stearothermophilus. These test strips can be used for monitoring autoclaves, chemiclaves and dry heat sterilizers.

Spore test results - what do they indicate?

A negative spore test (a test that has no growth) tells the operator that the process was adequate to kill the spores. A positive spore test (a test that shows growth) indicates a failed process and the load is not sterile.

Positive spore test results could be caused by: packs that are improperly prepared; the sterilizer is overloaded; the sterilizer does not work properly; or the process time is too short.

According to the Centre for Disease Control guidelines…. "if spores are not killed in routine spore tests, the sterilizer should be checked for proper use and function and the spore test repeated. If the spore test remains positive, use of the sterilizer should be discontinued until it is serviced."