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http://dx.doi.org/10.17245/jdapm.2021.21.3.227

Implementation of contextualized, emergency management cognitive aids in a periodontics clinic  

Siemens, Mikaela J. (Duke University Nurse Anesthesia Program)
Rice, Andi N. (Periodontics of Greenville)
Jensen, Trenton F. (Periodontics of Greenville)
Simmons (Muckler), Virginia C. (Duke University Nurse Anesthesia Program)
Publication Information
Journal of Dental Anesthesia and Pain Medicine / v.21, no.3, 2021 , pp. 227-236 More about this Journal
Abstract
Background: Emergencies in outpatient clinics are rare. However, potentially catastrophic events can be challenging to manage due to a variety of factors, including limited equipment and staff. The purpose of this quality improvement project was to improve the staff knowledge and familiarity with critical performance elements for emergencies encountered in the setting of a periodontics clinic. Methods: Emergency cognitive aids tailored to the clinic's resources were created for anaphylaxis, airway obstruction, and sublingual hemorrhage. The project pre-post-test repeated measures design evaluated the effectiveness of cognitive aids using a combination of hands-on simulation, written knowledge assessments, and self-efficacy surveys. Training sessions and simulations were provided to the clinic's existing care teams made up of a periodontist and two dental assistants with an anesthetist who was present for simulations involving sedation. Due to the small sample size (N = 14) and non-normal distribution, all metrics were evaluated using non-parametric statistics. Results: Significant improvements were found in knowledge assessment (-2.310, P = 0.021) and self-efficacy (-2.486, P = 0.013) scores when retention after a training session before and after the introduction of cognitive aid was compared. The mean simulation scores and times improved steadily or reached maximum scores during the project progression. Conclusion: Training sessions before and after cognitive aid introduction were effective in improving knowledge, self-efficacy, and simulation performance. Future projects should focus on validating the process for creating contextualized cognitive aids and evaluating the effectiveness of these cognitive aids in larger samples.
Keywords
Airway Obstruction; Anaphylaxis; Cardiac Arrest; Checklist; Emergencies; Hemorrhage;
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1 Smereka J, Aluchna M, Aluchna A, Szarpak L. Preparedness and attitudes towards medical emergencies in the dental office among Polish dentists. Int Dent J 2019; 69: 321-8.   DOI
2 Bains R, Bains VK. Lesions of endodontic origin: an emerging risk factor for coronary heart diseases. Indian Heart J 2018; 70: S431-4.   DOI
3 Goldhaber-Fiebert SN, Macrae C. Emergency manuals: how quality improvement and implementation science can enable better perioperative management during crises. Anesthesiol Clin 2018; 36: 45-62.   DOI
4 St. Pierre M, Luetcke B, Strembski D, Schmitt C, Breuer G. The effect of an electronic cognitive aid on the management of ST-elevation myocardial infarction during caesarean section: a prospective randomised simulation study. BMC Anesthesiol 2017; 17: 46.   DOI
5 Kim J. Pediatric advanced life support and sedation of pediatric dental patients. J Dent Anesth Pain Med 2016; 16: 9-15.   DOI
6 Smereka J, Aluchna M, Aluchna A, Puchalski M, Wroblewski P, Checinski I, et al. Medical emergencies in dental hygienists' practice. Medicine 2019; 98: e16613.   DOI
7 Lelaidier R, Balanca B, Boet S, Faure A., Lilot M, Lecomte F, et al. Use of a hand-held digital cognitive aid in simulated crises: the Medical Assistance eXpert 2 randomized controlled trial. Br J Anaesth 2017; 119: 1015-21.   DOI
8 de Bedout T, Kramer K, Blanchard S, Hamada Y, Eckert GJ, Maupome G, et al. Assessing the medical emergency preparedness of dental faculty, residents, and practicing periodontists: an exploratory study. J Dent Edu 2018; 82: 492-500.   DOI
9 Al-Sebaei MO, Alkayyal MA, Alsulimani AH, Alsulaimani OS, Habib WT. The preparedness of private dental offices and polyclinics for medical emergencies. A survey in Western Saudi Arabia. Saudi Med J 2015; 36: 335-40.   DOI
10 Simmons WR, Huang J. Operating room emergency manuals improve patient safety: a systemic review. Cureus 2019; 11: e4888.
11 Krishnamurthy M, Venugopal NK, Leburu A, Kasiswamy Elangovan S, Nehrudhas P. Knowledge and attitude toward anaphylaxis during local anesthesia among dental practitioners in Chennai - a cross-sectional study. Clin Cosmet Investig Dent 2018; 10: 117-21.   DOI
12 Roy E, Quinsat VE, Bazin O, Lesclous P, Lejus-Bourdeau C. High-fidelity simulation in training dental students for medical life-threatening emergency. Eur J Dent Educ 2018; 22: e261-8.   DOI
13 Woodward ZG, Urman RD, Domino KB. Safety of non-operating room anesthesia: a closed claims update. Anesthesiol Clin 2017; 35: 569-81.   DOI
14 Hardy JB, Gouin A, Damm C, Compere V, Veber B, Dureuil B. The use of a checklist improves anaesthesiologists' technical and non-technical performance for simulated malignant hyperthermia management. Anaesth Crit Care Pain Med 2018; 37: 17-23.   DOI
15 Evans D, McCahon R, Barley M, Norris A, Khajuria A, Moppett I. Cognitive aids in medicine assessment tool (CMAT): preliminary validation of a novel tool for the assessment of emergency cognitive aids. Anaesthesia 2015; 70: 922-32.   DOI
16 Schwarzer R, Jerusalem M. Generalized Self-Efficacy Scale. In: Measures in health psychology: A user's portfolio. Causal and control beliefs. Edited by Weinman J, Wright S, Johnston M. Windsor, England: NFER-Nelson. 1995, pp 35-37.
17 Maurer TJ, Andrews KD. Traditional, likert, and simplified measures of self-efficacy. Educ Psychol Meas 2000; 60: 965-73.   DOI
18 Grewal G, Joshi GP. Obesity and obstructive sleep apnea in the ambulatory patient. Anesthesiol Clin 2019; 37: 215-24.   DOI
19 Rutt AL, Bojaxhi E, Torp KD. Management of refractory laryngospasm. J Voice 2020; S0892-1997: 30481-3.
20 Nogami K, Taniguchi S, Ichiyama T. Rapid deterioration of basic life support skills in dentists with basic life support healthcare provider. Anesth Prog 2016; 63: 62-6.   DOI
21 Limongelli L, Tempesta A, Crincoli V, Favia G. Massive lingual and sublingual haematoma following postextractive flapless implant placement in the anterior mandible. Case Rep Dent 2015; 2015: 839098.   DOI
22 Nishizaki H, Morimoto Y, Hayashi M, Iida T. Analysis of intravenous sedation for dental treatment in elderly patients with severe dementia-a retrospective cohort study of a Japanese population. J Dent Sci 2021; 16: 101-7.   DOI
23 Coughlin PA, Featherstone CR. How to write a high quality multiple choice question (MCQ): A guide for clinicians. Eur J Vasc Endovasc Surg 2017; 54: 654-8.   DOI
24 Marshall SD, Sanderson P, McIntosh CA, Kolawole H. The effect of two cognitive aid designs on team functioning during intra-operative anaphylaxis emergencies: a multicentre simulation study. Anaesthesia 2016; 71: 389-404.   DOI
25 Harvey R, Foulds L, Housden T, Bennett KA, Falzon D, McNarry AF, et al. The impact of didactic read-aloud action cards on the performance of cannula cricothyroidotomy in a simulated 'can't intubate can't oxygenate' scenario. Anaesthesia 2017; 72: 343-9.   DOI
26 Spera AL, Saxen MA, Yepes JF, Jones JE, Sanders BJ. Office-based anesthesia: safety and outcomes in pediatric dental patients. Anesth Prog 2017; 64: 144-52.   DOI
27 Bandura A. Guide for constructing self-efficacy scales. In: Self-efficacy beliefs of adolescents. Edited by Pajares F, Urdan T. Greenwich, CT, Information Age Publishing. 2006, pp 307-37
28 Bucher JT, Vashisht R, Ladd M, Cooper JS. Bag mask ventilation. In: StatPearls. Treasure Island (FL), StatPearls Publishing. 2020.
29 Wright RA, Bidra AS, Kuo CL. An analysis of anterior mandibular anatomy by using cone beam computed tomography: a study of 225 mandibular images. J Prosthet Dent 2020; 123: 595-601.   DOI
30 Shaker MS, Wallace DV, Golden DBK, Oppenheimer J, Bernstein JA, Campbell RL, et al. Anaphylaxis-a 2020 practice parameter update, systematic review, and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) analysis. J Allergy Clin Immunol 2020; 145: 1082-123.   DOI
31 American Academy of Periodontology. Patient resources. American Academy of Periodontology 2019. Available from https://www.perio.org/consumer/patient-resources
32 Balaguer-Marti JC, Penarrocha-Oltra D, Balaguer-Martinez J, Penarrocha-Diago M. Immediate bleeding complications in dental implants: a systematic review. Med Oral Patol Oral Cir Bucal 2015; 20: e231-8.
33 O'Reilly-Shah VN, Kitzman J, Jabaley CS, Lynde GC. Evidence for increased use of the society of pediatric anesthesia critical events checklist in resource-limited environments: a retrospective observational study of app data. Paediatr Anaesth 2018; 28: 167-73.   DOI
34 Tomljenovic B, Herrmann S, Filippi A, Kuhl S. Life-threatening hemorrhage associated with dental implant surgery: a review of the literature. Clin Oral Implants Res 2016; 27: 1079-84.   DOI
35 Chaudhry S, Jaiswal R, Sachdeva S. Dental considerations in cardiovascular patients: a practical perspective. Indian Heart J 2016; 68: 572-5.   DOI
36 Hepner DL, Arriaga AF, Cooper JB, Goldhaber-Fiebert SN, Gaba DM, Berry WR, et al. Operating room crisis checklists and emergency manuals. Anesthesiology 2017; 127: 384-92.   DOI
37 Webster CS, Andersson E, Edwards K, Merry AF, Torrie J, Weller JM. Deviation from accepted drug administration guidelines during anaesthesia in twenty highly realistic simulated cases. Anaesth Intensive Care 2015; 43: 698-706.   DOI
38 Saxena S, Krombach JW, Nahrwold DA, Pirracchio R. Anaesthesia-specific checklists: a systematic review of impact. Anaesth Crit Care Pain Med 2020; 39: 65-73.   DOI
39 Acar YA, Mehta N, Rich MA, Yilmaz BK, Careskey M, Generoso J, et al. Using standardized checklists increase the completion rate of critical actions in an evacuation from the operating room: a randomized controlled simulation study. Prehosp Disaster Med 2019; 34: 393-400.   DOI
40 Siddiqui A, Ng E, Burrows C, McLuckie D, Everett T. Impact of critical event checklists on anaesthetist performance in simulated operating theatre emergencies. Cureus 2019; 11: e4376.