FYI

On-site Quality Assessment (QA) reviews are part of our Quality Assessment program for dentists in California, mandated by the California Department of Managed Health Care.

A QA review gives you a look at how the many components of your practice compare to the expectations of dental professionals, regulatory agencies, dental educators and Delta Dental.

QA reviews are conducted in two parts:
 

1. Structural (about 20 minutes): Review of your facility and equipment, as well as emergency, sterilization and infection control protocols.
2. Records (about 1 hour and 45 minutes): Review of patient treatment documentation for relevance and acceptability under current standards of patient care.
    

The following list highlights just some of the aspects of a QA review, and is a useful tool to help you review your practice through the eyes of the QA examiner. Together with your staff, you can evaluate your office policies and procedures and be even better prepared for a future on-site QA review.
 

Structural review

Facility and equipment

• Facility is clean and well-maintained, dentist name and office hours are posted
• Procedure manual includes written protocols for new and recall appointments, documenting complaints, broken appointments, specialty referral
• Accessibility/reasonable accommodations exist for patients with disabilities, such as wheelchair access and a grab bar in the restroom
• Waterlines have anti-retraction valves installed and maintained, handpieces and waterlines are properly flushed
   

Radiology

• Certificates are current and equipment inspection dates are posted
• Lead or lead-equivalent apron with thyroid collar is used
   

Sterilization and infection control

• Staff is trained in infection control standards and logs are kept of procedures followed
• Gloves, masks, protective attire and eyewear are used appropriately
• Weekly biologic monitoring is conducted and records are kept
• Instruments and handpieces are properly sterilized, stored and labeled
   

Safety and emergency procedures/equipment

• Drugs, syringes and needles are properly stored; a log is kept of drugs dispensed on site
• Required certifications are up-to-date
• A modern evacuation system exists for nitrous oxide
• Written office protocol includes staff responsibilities for assisting/evacuating patients in emergencies or natural disasters, evacuation plan is posted and exits marked
• An active contact system can reach the dentist 24/7
• Portable emergency oxygen is available, tank is full and there is a positive pressure valve and/or Ambu bag; staff are trained in use
• Mercury hygiene and safety requirements are observed
• Medical emergency kit is up-to-date
   

Records review

Medical and dental history

• Medical history forms include yes/no questions, identify patient’s existing conditions and contain comprehensive health information
• Dental history includes baseline information, TMJ/occlusion status, appliances, periodontal condition and results of soft tissue/oral cancer exam
   

Treatment notes

• Progress/treatment notes are legible and in ink
• Included, as appropriate, are: 
  • Referrals to specialists
  • Records forwarded or received
  • Anesthetic used (type, amount and concentration of any vasoconstrictor)
  • Medications prescribed
  • Laboratory instructions
     

Quality of care

• Professionally acceptable standards of care are observed for: 
  • X-rays - adequate number, appropriate frequency, of diagnostic value, mounted and labeled
  • Treatment plan - in ink, consistent with diagnosis and exam findings, alternative and elective treatment documented with the patient’s choice and reason
  • Treatment sequence - in order of need
  • Informed consent - documentation that treatment plan was reviewed and patient understands risks, benefits, alternatives and costs; documentation of any refusal of recommended care
     

Outcomes of care

• Patient records demonstrate effectiveness of preventive care
• Overall comprehensive documentation demonstrates that treatment was provided as appropriate, including: 
  • Good prognosis for appropriate longevity
  • Evidence of need (x-rays, pocket charting, etc.)
  • Minimal unplanned treatment/retreatment
  • Referral to a specialist in a timely manner
  • Post-operative instruction given
  • Follow-up (pocket charting, x-rays, etc.)