Introduction

The GDC “Maintaining Standards” document states that a dental team should be properly trained to deal with a medical emergency. This training should include rehearsal of resuscitation routines during a simulated emergency. In addition, practitioners have an obligation to be conversant with the current Resuscitation Council (UK) Guidelines.

Skill decay amongst other professionals, namely medical and nursing professions is high. Evidence exists that upon testing many professionals are not “competent” at administering “effective” CPR. The participants in such studies were aware that their basic life support skills would be tested, and had all attended a training course within the previous 12 months. While confidence levels were high, competency levels were low, supporting the need for refresher courses as regularly as every 6 months.

Consequently, in this audit the following specific aspects with respect to (adult) basic life support have been looked at:

Staff responsibilities
Practice policy
Documented work instructions
Staff training and training records
Emergency equipment and drugs
Practical casualty assessment skills
Practical CPR skills

Objectives

(1) To assess the practical skills, training and the administrative support for basic life support, throughout the dental practice

(2) To achieve the ideal standard of basic life support throughout the dental practice, consistent with the current Resuscitation Council Guidelines

Method

A comprehensive list of performance criteria which would represent the ideal standard of performance of basic life support was obtained from the Resuscitation Council.

A unique data capture form was drawn up which directly corresponds to the performance criteria. The marking criteria for each stage were defined to give 3 possible answers, which were graded from A to C and which takes into account graduations of performance. In summary, grades A to C were defined as follows:

A - Performed satisfactorily

B - Performed unsatisfactorily

C - Not performed

Five clinical teams exist in the practice, all of whom were to be included in the audit. To ensure independent non-bias audit, no clinician was responsible for auditing his or her own CPR basic life support skills.

A real-time cardiac arrest simulation was conducted for 4 minutes, without interruptions. A video camera was used to record each clinical team’s management of cardiac arrest. The camera was placed high up in the surgery to provide a wide field of view. A Laerdal manikin, with an instant correct feedback device, was used to record ventilation and compression characteristics which were visible on the video recording. The teams’ only instructions were “… you have an unresponsive patient, not breathing and pulse … please manage the situation as you have been trained”.

The video recording was analysed after each audit and the unique data capture form was used to evaluate each clinical team based upon the marking criteria. Each procedure was graded and uniquely numbered. The unique number would correspond to the written notes made on the system’s audit report summary table, which would specify the nature of the non-conformance to whom it applied and to the corresponding corrective actions required and timescale before the next audit cycle.

The numbers of each cycle were recorded in Microsoft Excel and a summary bar charge shows how well the whole practice performed.

The standard set was to achieve 80% ‘A’ grades.

Before each subsequent audit the standard was reviewed. Three cycles of audit were completed.

Results

Audit 1

Large numbers of non-conformances were found on the initial audit cycle and trends in non-conformance over all teams were apparent. This was just 3 months following the CPR/Basic Life Support training in August 2001. The main areas of non-conformance that prevented the practice from meeting the standard set were documented in detail. Subsequently, following several practice meetings, corrective actions were proposed which were implemented prior to the next audit cycle. A peer-training model was applied during the basic life support training.

Audit 2

There was a large improvement in the practice’s performance in the 2^nd audit. The results showed a large increase in the “A” grades – from 30% in the 1^st audit to 72% in the 2^nd but the standard set, to achieve 80% “A” grades, was still not met. There was a large reduction in the number of non-conformances relative to the ideal standard but some trends of non-conformance identified in the initial audit cycle, were still apparent in the 2^nd audit cycle. The main areas of non-conformance were documented in detail. Subsequently, following a practice meeting, corrective actions were proposed which were implemented prior to the next audit cycle.

Audit 3

This cycle showed a great improvement from the previous 2 audits with a large increase in “A” grades – from 30% in the 1^st audit to 93% in the 3^rd. No “C” grades were recorded so all actions had been performed. No trends in non-conformance over all teams were recorded in the 3^rd audit but there were still a small number of non-conformances recorded. The main areas of non-conformance were documented and corrective actions proposed.

Figure 1 – Adult Basic Life Support Data Capture Form

Adult BLS/CPR Data Capture Form

Team ………………………………………….

Assessor ………………………………………. Signature …………………………….

*Sequence*	*1^st Audit*	*2^nd Audit*	*3^rd Audit*
Dangers
Responsiveness
Unresponsive
Checks and clears airway
Opens airway
Checks breathing
Not breathing
2 breaths
Checks circulation
No pulse
Dials 999
Compressions
Ventilations
Ratio
Airway adjunct: bag & mask
Sequence

Graph