Reflection on Key Leaning in Oral health care
Reflection on Key Leaning
Name:
Module Title and Number:
Course Instructor:
Date of Submission
Stage 1: Description of the event
Describe in detail the event you are reflecting on, including such detail as where were you, who else was there, why were you there, what were you doing, what were other people doing, what was the context of the event, what happened, what was your part, what parts did the other people play, what was the result.
It was my third year as the head of a schoolchildren dental centre. I was working in the morning shift as clinical and administration supervisor when the reception called me for a trauma case in one of the centre’s clinics. The patient was a nine year-old boy waiting with his mother. When I asked the dentist about the case, he told me that the child had fallen and lost his permanent upper right central tooth, and a stitch is done for the socket. I was surprised but did not show my shock to the mother, as we were trying to calm the child. I asked the mother about what happened, she told me that her child had a fall the previous night and was attended to at the polyclinic in her neighbourhood.
After examining the child and asking her why the dentist put the stitch, she mentioned that the dentist advised the stitch to stop the bleeding. However, the upper permanent right central was not in its place and I requested a radiograph for the patient for a proper diagnosis and exclude the likelihood that the tooth had intruded inside the socket. The results of the radiograph confirmed that there was no hidden tooth and the mother said that she had the tooth at home because she was not aware that it could be re-implanted or it can be stored in milk or even water for maintenance. She also informed me that the dentist at the polyclinic didn’t ask her about the tooth. Although I knew the prognosis was not good, I called one of my colleagues well trained in dealing with these cases at another school children dental centre. I informed her that the trauma was less than 24 hours, but the tooth was not preserved in milk or water. I also removed the stitch and referred the patient to her with the tooth.
My colleague informed me later that she cleaned the tooth, extracted the pulp outside the patient’s mouth, finished the root canal and then re-implanted the tooth. Thereafter, a splint was inserted to hold the tooth. The colleague also scheduled follow up appointment for the child but she said the prognosis is bad because the right treatment was not given at the right time.
Stage 2: Feelings
Try to recall and explore the things that were going on inside your head, such as why does this event stick in your mind? Include how you were feeling when the event started, what you were thinking about at the time, how did it make you feel, how did other people make you feel, how did you feel about the outcome of the event, what do you think about it now.
I was really disappointed about the child’s situation, considering the fact that he risked losing a permanent anterior tooth, which would affect his appearance and his psychological health, especially since the permanent restoration (implant or bridge) cannot be done before the age of 18. The mother came to our clinic late and that made me helpless. I also wondered how the general practitioner (GP) at the polyclinic could perform a stitch for the socket, which did not allow normal healing without even asking the mother for the tooth.
I spoke to my boss over the phone and she told me to talk to the GP to try to get information about how he dealt with the case. I called him and advised him the importance of referring a patient when the case was complicated. He told me that he thought the tooth was lost and used stitches because he believed it would stop the bleeding.
Thinking about it now, I found that the GP did not follow the safety measures on consent, referral for complicated cases and post-operative care. The outcome would have been different if he had followed treatment principles on healing relationships, customized care, informing patients on the treatment, collaboration with a colleague and he didn’t take evidence-based decision to assure patient safety.
Stage 3: Evaluation
Try to evaluate or make a judgement about what has happened. Consider what was good about the experience and what was bad about the experience or didn’t go so well.
My judgement on the situation is that medical errors are not new and can happen to children every day. The trauma situation would have been better handled if the dentist understood the dimensions and drivers of quality in diagnosis and treatment. The case taught me that dentists do not have sufficient knowledge and training on dental trauma prevention and treatment guidelines which affect the patient’s safety. The good thing is that the dentist was willing to undergo training to improve his decisions on interventions, treatments, regimen, minimal restoration, patients’ risk status and causal factors. The experience motivated me to create and propose quality improvement strategies for my organization in dental trauma issues.
Stage 4: Analysis
Break the event down into its component parts so they can be explored separately. You may need to ask more detailed questions about the answers to the last stage. You should include what went well, what did you do well, what did others do well, what went wrong or did not turn out how it should have done, in what way did you or others contribute to this.
The child dental trauma results in loss of permanent anterior tooth, which will affecting the child’s psychology functional activity and aesthetics. What went well is that the organization later implemented the American Academy of Paediatric Dentistry (AAPD) guidelines on dental trauma management. Other dentists benefited from this experience because their awareness of safety and quality control became apparent.
I realized that my contribution to prevent the occurrence of such incidences in the future is to encourage teamwork so that the safety of the patient assured and risk of teeth loss due to malpractice decreased. As the head of school children dental centre, I will improve quality control measures by evaluating health education and prevention procedures done by the organization’s teams.
Stage 5: Conclusion
This differs from the evaluation stage in that now you have explored the issue from different angles and have a lot of information to base your judgement. Here you need to develop insight into you own and other people’s behaviour in terms of how they contributed to the outcome of the event. Remember the purpose of reflection is to learn from an experience. Without detailed analysis and honest exploration that occurs during all the previous stages, it is unlikely that all aspects of the event will be taken into account and therefore valuable opportunities for learning can be missed. During this stage you should ask yourself what you could have done differently.
Based on what happened, the steps towards education in the field of trauma management should have been implemented much earlier specially to general practitioners in polyclinics and primary care centres. The experience shows that lower levels of knowledge and inexperience can adversely affect the service quality. However, training and teamwork is paramount to a safe, efficient and patient-centred care. In addition, dentists should ensure healing relationships with patients by providing customize care and inform patients on methods of managing their oral healthcare and how to prevent dental trauma and how to deal with it if it happened.
Stage 6: Action plan
During this stage you should think yourself forward into encountering the event again and to plan what you would do – would you act differently or would you be likely to do the same?
I plan to propose a safety framework addressing health issues on education, prevention and treatment. This framework suggests that my organization should engineer their processes to meet changes, manage knowledge and talent through training, develop effective teams and coordinate care across patients, referral clinics and services. To prevent similar future occurrences, I propose open communication between parents, teachers, care givers and clinicians to educate them how to prevent and deal with these injuries and arranging scientific courses to help the clinicians to take evidence-based decisions.
