Patient safety: A note from Dr. McNeill
Patient safety and comfort have always been very important to me. During 2016 I was selected to a Blue Ribbon Panel as one of six dentists to investigate the issue of dental sedation safety. This panel was formed by the Texas state dental board upon recommendation by the state legislature.
As a board certified oral and maxillofacial surgeon, I have taken the following steps over the years to improve patient safety in my office. This includes anesthesia training with active simulation mannequins for myself and my staff through the American Society of Dental Anesthesia. This is a great training module for our entire team to go through different patient emergency scenarios as an entire team. You can hear breathing changes, see movement, administer medications, place airway devices and see vital signs. This is a great benefit to the entire team. We also perform monthly in office emergency drills. This is a great way to go through simulations with our own equipment in our own location. Some offices will have dentists who travel from office to office to remove teeth or place implants. I feel that my patients are best served when treated in my office that is equipped for the management of surgical patients with my own staff and equipment in a location we work in every day.
I am currently a part-time staff dentist with the investigations unit with the Texas State Board of Dental Examiners. In this position, I evaluate situations when then do not go well in dental offices. This gives me a broad range of experience to see what happens when problems occur. In part, I use this information to help improve my own patient care. I also speak on the subject of patient safety to other doctors.
My specialty association also performs in-office inspections to ensure that adequate protocols are being followed for patient safety. We have a specific safety officer in our practice and her responsibility is to ensure that our safety protocols are followed. In addition to this, I have done additional training to help optimize the patient experience. This can also have a significant impact on safety. I’m currently engaged in a two year Fellowship in Integrative Medicine through the University of Arizona School of Medicine. One of the benefits of my fellowship training is that it has given me the ability to utilize various non-pharmacological techniques to improve patient safety and comfort. There are side effects with all medications and my goal as a surgeon is to make a procedure as safe and comfortable as possible while minimizing the medications that I use. Many of the negative outcomes involving sedation in a dental office are caused by higher dosages of sedation drugs. Unfortunately, as the dosages go up so do the complications. I have taken a multifaceted approach in my office to do what we can prior to the procedure to decrease the need for higher medications. Several of these approaches deal with decreasing stress before the procedure. One simple example may involve specific breathing techniques to help alleviate stress and the increased sympathetic discharge that is taking place. Higher dosages of medications are often needed to blunt this “fight or flight” reaction if it is not reduced in other ways. Other approaches, especially for younger patients may involve a specific speaking style and word selection that utilizes my training through the American Society of Clinical Hypnosis to improve safety and comfort. I try to have a variety of “tools in my toolbox” to customize my approach for each individual patient. Every patient is different and I certainly feel the same about managing your anesthesia requirements.
I hope that you find this information helpful and allow you comfort in knowing that your safety is a priority.
Robert G. McNeill, D.D.S., M.D.
The following are answers to a list of questions the Dallas Morning News article advised patients ask their dentist. To reassure both you and your patients that we make safety a priority I have outlined answers to these questions.
- Have you checked your dentist online via the state board website? I hold an active dental and medical license in the State of Texas without restrictions, suspensions or disciplinary action.
- Does your dentist put on fresh gloves before treating you? We do not reuse items such as gloves and try to use single use items as appropriate.
- Do you receive protective eyewear before treatment? Patients have the option of wearing protective eyewear such as their sunglasses. I have found this can interfere with nasal masks if being used and therefore can be difficult to use at times. The patient has the option of moist protectors being placed over the eyes if desired.
- Before treating or pulling a tooth, does your dentist verify that it’s the correct one? We verify the procedure to be performed prior to the start of the procedure. For several years we have been performing a surgical time out to make sure that the patient, staff and doctor are all on the same page. This is part of the reason that we very much appreciate a written referral prescription from a referring dentist.
- Does your dentist evaluate your current health and health history before drilling? We do evaluate your current health history prior to a procedure. One of the benefits or a pre-surgical consultation as a separate appointment is that it provides the ability to communicate with other doctors involved in the patient’s care when appropriate as well as discuss ways to best prepare for the procedure.
- Has your dentist recommended wisdom tooth extraction? As an oral surgeon I have seen too many cases of infections associated with wisdom teeth. I will also have a discussion about comparing the risks and benefits of removal with the patient being mindful that complications can increase as a patient ages.
- Are you considering dental sedation? The patient/family will determine what is appropriate for their situation. Many patients find sedation to be the most comfortable way to have oral surgery performed.
- Do you know how much emergency training and equipment your dentist has? We do many things in our office to optimize safety. These include anesthesia training with active simulation mannequins for myself and my staff through the American Society of Dental Anesthesia. We also have monthly in office emergency drills. I also have assistants who are certified by the Dental Anesthesia Assistant National Certification Examination. As the doctor, I have basic life support (BLS), advanced cardiac life support (ACLS) and pediatric advanced life support (PALS) certifications. I am licensed by the state board to provide general anesthesia. We have an AED, airway supplies and an emergency drug cart available at all times.