• Michelle Strange, MSDH, RDH

Standard Operating Procedures (SOP) in Dentistry

Standard Operating Procedures (SOPs) are the building blocks of any successful organization. As professional tasks have become more complex, making it almost impossible to be free of mistakes, SOPs and checklists are becoming an integral part of work. In his book “The Checklist Manifesto”, Atul Gawande describes how true experts, who cannot afford to make mistakes, make use of checklists to complete their tasks successfully. A perfect example is in the aviation industry, where the smallest error can have dramatic results. The same principle applies to dentistry. Overlooking a small step in operating procedures can lead to an infection or other issues for a client, which can not only be detrimental for them but can also have devastating consequences for the reputation of a dental practice and possibly the health of the team.

When Things Go Wrong

The implementation of SOPs covering every aspect of work is even more critical during the current COVID-19 pandemic. Many organizations do not see the value of employing such strategies initially, but when an error occurs, they quickly realize the value of having checklists and protocols in place. Very few businesses ever regret incorporating SOPs as they provide clearly defined guidelines and structure. In the dental profession, taking SOPs seriously can reduce the risk of both minor and major issues. However, when something unfortunate does happen, demonstrating that all safety recommendations and protective measures were in place can minimize liability.

In a recent survey conducted by Dental Economics magazine, more than 30% of respondents were unsure or confirmed that there were no protocols in place if biological monitoring fails. As biological monitoring is such an essential part of infection control, knowing that almost a third of practices do not have defined guidelines to deal with a failing, is very worrying. So while initially, practices might not see the need for SOP’s, when things do go wrong, they will be relieved that they can show that they followed proper procedures. Having comprehensive SOPs in place will decrease the chance of errors and provide dental healthcare professionals (DHCPs) with a plan B if a rare error does occur.

Your SOP Checklist

Standard operating procedures must also meet certain demands to be qualitative. The following six elements should be part of your SOP creation checklist:

  1. The reason for the SOP: Clear communication of what the SOP is trying to achieve is essential. Teams will be more motivated to comply with them if they understand why they are important.

  2. The SOP date: It is crucial to keep SOPs updated, especially in times of pandemic. The date alsomakes team members aware of any changes made, which procedures may be new, and if further training is required.

  3. The scope of the SOP: The scope notation sets out what areas are covered.

  4. The responsible party or parties: Who is responsible for implementing these SOPs? Moreover, who should comply with them? Communicating responsibilities removes doubt and prevents blame games.

  5. The procedure’s actual steps: Through words and illustrations, precisely define the processes and procedures step by step.

  6. The key elements of success: Outline what success looks like and achieve it through constant revaluation. SOPs should be reviewed and revised when needed and adapted to changing circumstances.

Applying SOPs and Team Training

Of course, SOPs are only useful through their correct implementation. In the survey mentioned above, almost half of the respondents said they were unsure if their teams received adequate training on proper instrument processing. This shows that even if the practice has the most brilliantly detailed SOPs, they are useless unless they are in constant, consistent use. The need for constant training of teams on updated processes and procedures is an intrinsic part of ensuring SOPs are effective.

One way to maximize compliance is to have the team participate in the process of setting up the SOPs. If team members know why these procedures are in place, they can use their acquired experience and insights to propose the right procedures. This active involvement can skyrocket the motivation to comply with the processes.

Once a format is chosen, it is vital to stick to it and keep it simple to reduce confusion and increase compliance. The team should not only receive initial training, but it requires repeating at least yearly to refresh memories and inform everyone of any possible updates. The goal of SOPs is to make work easier, and simplicity and consistency are essential to get everyone on board.

SOP’s During a Pandemic

It cannot be stressed enough how imperative SOPs are generally, but the pandemic offers a vital opportunity to reiterate this. The spread of COVID-19 shows that SOPs should not always be set in stone and must adapt to changing circumstances. The ADA provides guidance on its website to new recommendations to incorporate to already existing toolboxes. They also stress the importance of triage screening for dental emergencies to decide which patients are eligible for a visit and require priority.

Dental professionals should be aware of the correct use of personal protective equipment (PPE). Surgical masks, for example, are not enough, and the usage of N95 masks is preferred, with a positive seal around the nose and mouth. Since intraoral techniques may induce coughing, extra-oral radiographs can provide a solution to diminish transmission risk. Their website provides many extra resources for ensuring the safety of DHCPs and clients.

Incorporating standard operating procedures and following the ADA recommendations, leads to the enhancement of team workflow and the minimization of hygiene breaches. While setting up SOPs, it is important to involve the team to maximize compliance. Standard operating procedures are a must to encourage high standards of hygiene adherence by all dental professionals. If an error occurs or a crisis arises, the team will feel confident in knowing what to do, and this will reduce the stress in the workplace and improve the wellbeing of all personnel and patients.

[1] "The Checklist Manifesto | Atul Gawande." Accessed 4 Aug. 2020.

[1] "Standard Operating Procedures and COVID-19 | Group ...." Accessed 4 Aug. 2020.

[1] "Standard Operating Procedures and COVID-19 | Group ...." Accessed 4 Aug. 2020.

[1] "Summary of ADA Guidance During the COVID-19 Crisis." 24 Jun. 2020, Accessed 4 Aug. 2020.

[1] "ADA Coronavirus (COVID-19) Center for Dentists." Accessed 4 Aug. 2020.

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