Introduction Morecambe Bay Hospital Trust (MBHT) is a District General Hospital (DGH) based across three working sites across the North West of England – Lancaster, Kendal and Barrow-In-Furness. The Oral and Maxillofacial Surgery (OMFS) unit provide care for a population of around 320, 000 inhabitants. The majority of surgery carried out on a daily basis within the OMFS department includes exodontia. This poster will discuss and review the development of a ‘Local Safety Standards for Invasive Procedures’ (LocSSIPs) document which is implemented across the trust, with a target audience inclusion of all clinicians within the department.

Aims and objectives of the research project or activity The aims of the development of the LocSSIPs are to provide standardised care and minimise the risk of errors during exodontia (including wrong site tooth extraction). This document will identify an ideal individual patient pathway and best practice when undertaking a tooth removal. This will form the protocol pathway for the dental team.

Within the department, it is important all clinicians, registered practitioners and support workers involved within dental extractions are aware of the ‘best practices’ when safely carrying out procedures.

A review of significant events within the department, identify ‘wrong site dental extraction’ as an error that may be avoided. The universal use of the LocSIPP document will serve as an aide memoire for reducing the risk of errors and identifying the local protocol to be adhered to should unforeseen circumstances occur.

In 2015, the National Safety Standards for Invasive Procedures (NatSIPPs) was developed as a fundamental initiative by NHS improvements. This would unite local and national understanding of Never Events, Serious untoward incidents and near misses. This would help to provide safer care and quality for patients undergoing treatment. This later encouraged the development of local protocols and hence the term ‘LocSIPP’. In England, the General Dental Council (GDC) and Care Quality Commission (CQC) support the use of NatSIPPs.

Reviewing when near misses, significant events or never events are encountered, allows the team to learn and attempt to avoid future incidences. Educational understanding of these incidents can be beneficial for Continuing Professional Development (CPD). These are usually discussed at Audit/Morbidity and Mortality meetings, with an open-door policy.

Method or approach The development of the LocSIPP is a fundamental part of patient procedure safety which considers human factors, CPD and record keeping which all provide a template of evidence which lead to the modification of systems and protocols. The anticipated benefits of this departmental LocSIPP for exodontia is to pre-empt any possible risks which may attribute to a failure to provide optimum patient treatment and care. This designed LocSIPP will be published on the Trust Intranet, for easy access for all team members to revise. This would also serve as a ‘how to guide’ for new starters within the OMFS department for the foreseeable future.

There was noted very little resistance to developing this guidance, as this appears to be for beneficial use for all stakeholders at MBHT.

In healthcare, we have a commitment to quality of care and working together to improve care provision for our patients. The desired outcomes from this LocSIPP would be a thorough understanding of gold standard local guidelines and patient flow for exodontia by all members of the maxillofacial team and associated colleagues, both in our outpatient department as well as in the operating theatres. It acknowledges human factors and error risks and aims to mitigate these through various checks. As a result, we hope this would lead to minimising risk of error and therefore improved patient care.

Creating a LocSSIP for our team to follow encourages uniformity and optimal care within the department across all sites and allows us to support our team by providing them with guidance on procedures.

This LocSIPP can be reproduced across other localities as it has been developed using current standard evidence-based guidance. It can be amended based on local protocol and differing facilities to suit other areas.

Findings This LocSIPP has been designed based on the patient pathway from treatment planning of exodontia all the way through to aftercare once the procedure has taken place. It has been created based on patient’s best interests, prioritising their care throughout the process.

There has been a significant shift in focus within healthcare from an accusatory view on mistakes and ‘never events’, towards understanding the impact of human factors and issues within our systems and what we can do to prevent them. This shift in focus has involved implementation of more comprehensive guidance to help mitigate risk of mistakes and counteract issues caused by human factors. When errors occur, we are encouraged to reflect on why they happened and what we can do to prevent them from happening again. This LocSIPP provides a standard for all team members to abide by to minimise risk of error and support good practice.

This LocSIPP could have been created earlier as we have been carrying out exodontia treatment in the Maxillofacial department since it was established. Although clinicians generally carry out procedures very similarly due to guidelines and taught knowledge, there has been no official protocol.

A potential barrier would be accessing information and making it available on hand for clinicians to use in clinic and in theatres.

Key messages We can use audit to measure the effect of improvement by looking at standard criteria being met before and after implementation of the exodontia LocSIPP. If standards are not being met or the LocSIPP not being used appropriately, we can continue to educate our department and raise any issues with LocSIPP usage during departmental meetings. This could be followed by another round of audit to address any issues.

Improvement can be implemented from when the department is first made aware of the LocSIPP. It can be addressed at a departmental audit meeting where it can be presented to the department and any questions or feedback from the team can be raised. Data can be collected from before the LocSIPP’s implementation and afterwards to compare practice and assess improvement. Results from this can also be presented at audit meetings to inform the department on our progress. Improvement would also be assessed via staff satisfaction questionnaires.