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Clinical Audit Report

Clinical Audit Report - BACD

 

The British Academy of Cosmetic Dentistry (BACD) aims to promote clinical excellence through education, certification and professional development. Formed in 2004, they now have over 1000 members.

Since 2005 the BACD have been producing an annual practice clinical audit (based on cosmetic treatments). Information for the previous calendar year is collected and analysed by a statistician and the combined results are then sent back to participating practices so they can track trends and benchmark their success rates.

A clinical audit based on the BACD one, and which is automatically completed based on patient treatment information, has now been integrated into EXACT in order to allow you to create your own report on failed work, as an aid to on-going quality control. If your practice is a BACD member you will also be able to output the report in the format specifically required by the BACD.

There is a facility for setting up services to have the new treatment types required for the audit, and for setting up those treatment types and their failure modes. Although the clinical audit is based on the BACD audit, you are able to add new clinical audit categories and attach service items to them, to create your own internal audit of your work. New audit categories created by you will be independent of and not affect output to the BACD for cosmetic work.
There is also a facility to add historical failures to treatments, and a report (including export) to print out a summary of those failures.

 

Summary of Features

  • EXACT has been updated to include standard BACD Failure Categories and their corresponding Failure Modes in the Services database.
    If you are a user with Admin rights you can also create non-BACD categories if you wish to.

  • The Add Service Item and Edit Service Item windows now have a new field called Failure Category to allow you to add the failure category to any services that you wish to.

  • There are windows to allow you to add Failure Categories and edit Failure Categories as required, and to view and edit the Failure modes for each one.

  • The Treatment History window has a new button to allow you to mark a treatment as failed. This button will open a dialog window to enable you to enter details of the treatment failure.

  • The Provider Details window now has a new field called "BACD Membership" to record and display BACD membership.

  • A Clinical Audit Report is available from the Reports menu at Administration > Reports.

 

Clinical Audit Report

The Clinical Audit Report allows you create a report of failed work, based on patient treatment information, as an aid to on-going quality improvement. If your practice is a BACD member you will also be able to output the report in the format specifically required by the BACD.

To use the report first ensure your practice is set up for clinical audits.

To Run the Clinical Audit Report

  1. Select Administration > Reports and then in the Reports screen select the Clinical Audit Report:

    This will display the Print Clinical Audit Report window:

    As a non-BACD member:

    • This enables you to change the date range for the report (defaulted to the current calendar year), and to select either a detailed report output or summary only.

    • The report will include treatment failures for any services provided that had non-BACD Failure Categories set up against them.


    As a BACD member:



    • This window enables you to change the date range for the report (defaulted to the current calendar year), and to select either a detailed report output or summary only.

    • If you tick the BACD Only checkbox, these options are greyed out. The report will default to the current calendar year, and will show only your failed work for treatment you have provided that had BACD Failure Categories set against the services provided.

    • If you leave the BACD Only checkbox unticked, the report will include treatment failures for any services provided that had either BACD Treatment Categories or non-BACD Failure Categories set up against them.


    As an Administrator in a practice where there are NO providers with BACD membership:

    • You can select a Provider or choose several Providers using the [Multiple] button, or enter/select a Provider Category to choose providers assigned to that Category.

      If you choose multiple providers, you can choose to either amalgamate the details, or print each provider's details on a separate report.

    • You may change the date range for the report (defaulted to the current calendar year), and select either a detailed report output or summary only.



    As an Administrator in a practice where there ARE providers with BACD membership:



    • If you click the BACD Only checkbox, the options are greyed out, the report will default to the current calendar year, will default to Summary Only mode, and will show only failed work for treatment provided that had BACD Failure Categories set against the services provided.
      Only BACD providers will be included, and you will not be able to choose either individual providers or multiple providers, but can select BACD providers belonging to a particular category.
      If you leave the Provider Category blank, any BACD providers' failed treatment will be reported.

    • If you leave the BACD Only checkbox unticked, the report will include treatment failures for any services provided that had either BACD Treatment Categories or non-BACD Failure Categories set up against them. You can choose either individual or multiple providers, or providers with a particular Provider Category. You can also change the defaulted date range.

 

 

 

 

 

Report Output

The report will list for each provider the following:

  • The provider's full name and BACD Membership number.

  • For each service a count of the services (by male and female) and a count for each failure mode.

  • After printing all the services within a category, a summary for that category is printed.

  • If a service does belong to a category but does not have any failures it will not listed on the report.



After all provider's details have been printed, a summary for the whole report is printed.



 

Clinical Audit Report example - All providers



  • If you choose "Summary Only", the report will amalgamate and total the number of failures for each Failure Category.
    Services not in a category are still shown individually.

  • If the "BACD Only" option is selected, those failures that are not flagged as BACD failure categories are not reported.
    Also, at the bottom of the report, additional instructions are printed on how to fax the report to the BACD.

    Clinical Audit Report example - "Summary Only" mode

 

Clinical Audit Setup

In order to make use of the Clinical Audit facility for cosmetic dental treatment, the following things need to be set up and maintained in EXACT:

  1. BACD Membership - the Clinical Audit facility is available to all EXACT users, but if you wish to output the Clinical Audit Report in the required format to submit it to the BACD, you will need to be a BACD member, and enter your number in the Providers window (File > Providers):

    The number must be entered in the format BACDMxxxxx, where xxxxx is your five-digit membership number.

  2. Failure Categories / Modes - EXACT has the BACD Failure Categories and Failure Modes already set up for you (see Failure Modes for Failure Category Codes).

    If you wish to add your own (non-BACD) categories and modes to services, this is done via the Add Service Item window (if adding a new service as well) or the Edit Service Item window to add failure categories to existing services.

  3. The Failure Category field in the Service Item windows is accessible to any user with security access to edit services.

    However, the ability to add or edit Failure Categories and Modes must be set up for a user by someone with administrative rights, via the Configure > Security menu item for the user or the group they belong to:

  4. Failed historical treatment that has not yet been marked as such will need to be accessed via the Tooth History window on the patient's chart tab.

    The Failure button on this window enables you to 'tag' treatment for a patient as failed. See Failed Treatment (for Clinical Audits).

 

Configuring Failure Categories

  1. Failure Categories are attached to those services for which a failure is used for clinical audits. The Failure Categories can be viewed and edited via any of the screens on which services are listed, such as the Service List tab in the Patient Chart, or you can access services directly from the Configure > Services menu item.

    See Explanation of Failure Categories for further information.

  2. Once you have accessed the Services list, select the required service, then either double-click it, or click the Edit Details button.

  3. The Failure Category is displayed on the Service Details tab:

  4. To add a Failure Category or change the existing one, click in the Failure Category field, and select the required category using the or button. The button will display the View Failure Categories window, as shown above.The Failure Categories shown above are those that shipped with EXACT, and are all BACD categories.To create your own categories, click the button, which will display the Add Failure Category Details window.To edit a Failure Category, or view the Failure Modes for the category, click the Edit Details button, which will display the Edit Failure Category Details window.

  5. When you have finished in the View Failure Categories window, click the OK button to save any changes you may have made, or the Cancel button to exit without saving.

 

Creating your own Failure Categories

Click the [+1] button in the View Failure Categories window, which will display the Add Failure Category Details window:

 

Failure Category Name

Click in the field and enter a name for the new Failure Category; this must be unique to distinguish it from other Category codes.

[ ] BACD Category

If (and only if) this Failure category is an official BACD category, click the checkbox. Do NOT delete the tick on BACD codes unless instructed to do so by the BACD.

Failure Modes

This field is used to select the Failure Modes for this Category. Click in the field, and click the button to insert a Failure Mode into the list, or click on an existing Failure Mode code and use the button to remove it from the list.

 

Editing Failure Category Details

Click the [e|d] button in the View Failure Categories window, which will display the Edit Failure Category Details window:

 

Failure Category Name

Click in the field and enter a name for the new Failure Category; this must be unique to distinguish it from other Category codes.

[ ] BACD Category

If (and only if) this Failure category is an official BACD category, click the checkbox. Do NOT delete the tick on BACD codes unless instructed to do so by the BACD.

Failure Modes

This field is used to select the Failure Modes for this Category. Click in the field, and click the button to insert a Failure Mode into the list, or click on an existing Failure Mode code and use the button to remove it from the list.

 

Explanation of Failure Categories and Failure Modes

Standard (BACD) Failure Modes:

Failure

Any complications that lead the patient to return to you.

Aesthetic failure

A failure that the patient has made the provider aware of and wants correcting.

Whitening

If the patient had unrealistic expectations and there is a visible colour change (3 or more Classic vita shade guide shift) one week post whitening then do not record as failure.

Direct anterior bonding

Involves any composite material placed within the smile zone on the front six anterior teeth (upper or lower).

Endodontic treatment

Unplanned endo that is carried out after the definitive restoration is fitted. It is recorded in the calendar year it is started irrespective of when the restoration was placed.


Standard (BACD) Failure Categories:

Direct anterior bonding

Upper and lower front 6 teeth, e.g. UL1, UL2, UL3, UR1, UR2, UR3, LL1, LL2, LL3, LR1, LR2, LR3.

Posterior composite

Upper and lower for all teeth except anterior (see above).

Crowns, inlays, onlays

Any crown, inlay or onlay which is not implant supported.

Restored implant units

Implants that have been restored, i.e. definitive restorations fitted on the implants.

Orthodontic cases

Number of patients who have had orthodontic treatment as part of their current treatment plan.

Lingual orthodontic cases

Number of patients who have had lingual braces as part of their current treatment plan

Labial orthodontic cases

Number of patients who have had labial braces as part of their current treatment plan.



Please note: if a patient has lingual braces in one arch and labial in another count it as one case and use the brace in the UPPER arch.

Invisalign orthodontic cases

Number of patients who have had Invisalign as part of their current treatment plan.

Removable orthodontic cases

Number of patients who have had a removable orthodontic appliance to MOVE the teeth as part of their treatment plan (do not count appliances that are used to stop teeth from

 

Failure Modes for Failure Category Codes

The Failure Modes and corresponding Failure Categories as originally installed in EXACT are as follows:

Failure Modes

Failure Categories

Sensitivity leading to treatment discontinued.

Home Tray Whitening

Sensitivity for more than 24 hours

Surgery Whitening

Patient not happy with outcome

Home Tray Whitening

Surgery Whitening

Fracture

Porcelain Veneers

Crowns, Inlays and Onlays

Debond

Porcelain Veneers

Sensitivity after one month

Porcelain Veneers

Aesthetic failure

Porcelain Veneers

Direct Anterior Bonding

Posterior Composites

Crowns, Inlays and Onlays

Bridge Units

Implants Placed

Restored Implants

Endo

Porcelain Veneers

Posterior Composites

Crowns, Inlays and Onlays

Bridge Units

Chip

Posterior Composites

Sensitivity

Posterior Composites

Recement

Crowns, Inlays and Onlays

Porcelain fracture

Bridge Units

Suprastructure fracture

Bridge Units

Osseointegration failure

Implants Placed

Restored Implants

Restorative failure



Implants Placed

Restored Implants

Lingual Orthodontic Cases

Labial Orthodontic Cases

Invisalign Orthodontic Cases

Removable Orthodontic Cases

Gingival only Aesthetic Gum Recontouring

Gingival and Bone Aesthetic Gum Recontouring



Editing and Creating Failure Modes

In the Edit Failure Category Details window, click the Insert button to open the View Failure Modes window:

 

 

From this window you can use the Edit and +1 buttons to edit existing Failure Modes or add new Failure Modes.

To Edit a Failure Mode

Select it in the View Failure Modes window and then click the [e|d] button.

 

You should not edit any Failure Modes that has a YES in the BACD column, unless expressly instructed to by the BACD.

To Create a new Failure Mode

Click the [+1] button in the View Failure Modes window to display the Add Failure Mode window:

 

Only check the BACD checkbox if this is a BACD Failure Mode.

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