Chapter 40 Legal Issues, Quality Assurance, and Infection Prevention

When getting informed consent from the patient, whos responsibility is it to discuss the need for dental images and procedures?

the dentist

Federal and State Regulations

X-ray machines manufactured or sold in the United States after 194 Must meet federal requirements

Developer Strength

As the developer loses strength, the time-temperature chart is not longer accurate

To check the strength of the developer solution is to --COMPARE FILM DENSITIES against a standard

Done with reference radiograph or a step wedge radiograph or normalizing device

How long should it take for the film to "clear" when the fixer is at full strength?

within 2 minutes

Licensure Requirements

The Consumer-Patient Radiation Health and Safety Act is a federal law that requires persons who take dental radiographs to be properly trained and certified

Licensure Requirements

X-ray certification requirements for the dental assistant vary from state to state

What are 5 things patients must be told before signing informed consent?

1. Risks and benefits of radiographic procedures

2. Person who will be exposing the radiographs

3. Number and type of radiographs that will be taken

4. Consequences of not having the radiographs

5. Alternative diganostic aids that may provide the same information as dental radiographs

Who can be held legally responsible for the dental assistants actions?

the dental assistant and dentist in some cases

For patient records, what documentation of radiographs should be included?

-Informed consent

-Number and type of radiographs

-Rationale for requiring radiographs

-Diagnostic interpretation

Patients transfer radiographs to another office

-Dental images are the property of the dentist even though the patient or patient's insurance pay for them

-Patients may request a copy of their images should be written and signed by the patients

-Make an entry in the chart stating when and to whom duplicate or digital images were sent

-Never give or send original radiographs to a patient

The Consumer-Patient Radiation Health and Safety Act

is a federal law that requires persons who take dental radiographs to be properly trained and certified

How should contaminated film be handled?

use gloved hands, and discard outer package without touching inner package

Intensifying screens

should be periodically checked for dirt and scrateches

-chould be cleaned MONTHLY with a commercially available cleaner

-after cleaning,an ANTISTATIC solution should be applied to the screen to prevent static electricity that may affect film quality

-screens that appear visibly scratched should be replaced

Cassettes

should be checked for worn closures, light leaks, and warping, which may result in fogged and blurred radiographs

-damaged cassettes must be repaired or replaced

If the wire mesh image seen on the film exhibits uniform density, __________ contact has taken place.

Good film-screen contact

If the wire mesh image seen on the film exhibits VARYING densities, __________ contact has take place.

Poor film-screen contact

what surfaces must be covered with barriers?

All that aren't easily sanitized

When can sterilized image receptor positioning instruments be opened?

should remain packaged until the patient is seated and can view the opening of the package

What is Disclosure?

the process of informing the patient about a procedure

How often should the PROCESSING SOLUTIONS be changed?

change them every 3 to 4 weeks, as recommended by the manufacturer.

(daily)

4 Administrative Quality Control Steps

1. Develop and maintain a written description of the quality assurance plan

2. Assign specific duties to staff members, and ensure that each individual is thoroughly trained to perform those assigned duties

3. Maintain records of monitoring and maintenance

4. Review the plan periodically and revise it as necessary

What are three things the Recordd-Keeping Maintenance Log should include?

1. The specific test performed

2. The date the test was performed

3. Test results

At least 4 surfaces that are likely to be contaminated during x-ray procedures?

1. Exposure button

2. Lead apron

3. Dental Chair controls

4. Operatory Counter surfaces

What are image receptor positioning instruments?

X-ray film

Phosphor plate

Digital Sensor

How should contaminated film be transported to the DARK room?

only after your gloves have been removed, your hands washed and dried, the patient is dismissed and the area cleaned and disinfected then you can take the film

Checking "Freshness" of the dental X-ray film?

Check each box of film while opening it

Test for freshness:

-In the darkroom, unwrap one unexposed film from the newly opened box

-Process the film with the use of FRESH CHEMICALS

-If processed film appears clean with a SLIGHT BLUE TINT, the film is fresh and has been properly stored and handled. This film is safe for use

If the processed film appears fogged, the film has been improperly stored or exposed to radiation. This film, MUST not be used

Guidelines for Dental Radiography

1. Wear gloves when exposing radiographs and handling contaminated film packets

2. Use HEAT TOLERANT or disposable intraoral devices when ever possible

3. Transport and handle exposed film in an ASEPTIC manner to prevent contamination of developing equipment.

Following apply for digital radiography sensors:

-clean and heat sterilize or high level disinfect between patients barrier protected semi critical items

When educating a patient who fears exposure to radiation, what can the dental assistant tell the patient about BACKGROUND RADIATION?

the dose from FOUR BITEWING images is about the SAME as a SINGLE days worth of natural background radiation

Who legally owns the patients dental radiographs?

Dentist

What should be done if the patient refuses dental radiographs?

-educate the patient about the importance of dental radiographs

-it should be stated in the patients record if a patient refuses recommend radiographs

What does Quality Assurance in the dental office include?

means regular testing to detect equipment malfunctions, monitoring techniques, and scheduled maintenance

How will the dental x-ray film appear if it is FRESH and has properly been stored?

if the processed film appears clean with a SLIGHT BLUE TINT

What type of test is done to check the Safelight?

coin test

QUALITY CONTROL for PROCESSING SOLUTIONS

-you must replenish the processing solutions DAILY and change them every 3 to 4 weeks as recommended by the manufacturer

-You should check the solutions each day BEFORE any patient films are processed