Standardized Preoperative Tooth Documentation to Reduce Risk of Peri-Anesthetic Dental Injury

Abstract

Problem & Purpose: Literature confirms that peri-anesthetic dental injury (PDI) is one of the most common negative anesthesia-related events and a frequent topic in anesthesia-related litigation. There are over 30 reported PDIs per year at an academic level II trauma center In the mid-Atlantic United States. This quality improvement project aims to improve dental assessment and documentation to mitigate the risk of PDI at the project site. The population is adult inpatients receiving anesthesia, excluding obstetrics. Methods: The project lead (PL) and the site’s Chief Anesthesiologist selected a standardized numeric dental diagram. It was inserted into the physical examination section of the existing electronic pre-anesthesia evaluation (PAE). PAEs are completed preoperatively by anesthesia providers for all inpatients receiving anesthesia. Tooth numbers in the diagram are a reference for providers to accurately document dental damage. About 45 anesthesia providers were educated on access and use of the diagram. Real-time one-on-one demonstrations were provided. Step-by-step visual and written instructions were placed in anesthesia offices. The PL reviewed charts weekly to monitor compliance with numeric documentation of pre-existing dental damage. Results: The PL reviewed 659 charts. There were 461 charts excluded due to teeth within normal limits, presence of an endotracheal tube before surgery, edentulousness, lack of electronic PAE, lack of dental documentation in the PAE, inability to assess the mouth, and surgery on a weekend or holiday. The remaining 198 charts were included. Average compliance with using tooth numbers to document pre-existing dental damage was 47% during the 14-week implementation period. There have been at least two reported PDIs during those 14 weeks. Both PAEs revealed incomplete dental documentation. Conclusion: Evidence suggests a standardized numeric diagram can improve compliance with dental documentation. Literature states that thorough preoperative dental assessment and documentation can result in the anesthetist modifying airway instrumentation techniques to reduce PDI risk and lead to PDI-related litigation results in favor of the anesthesia department.