Transcript ASEAN Chief Dental Officers Meetings Quality of Dental Services in
ASEAN Chief Dental Officers Meeting:
Quality of Dental Services in Brunei Darussalam
Dr. Sylviana Haji Moris BDS (Dundee); MSc Dental Public Health (Kings College London) Head of Primary Oral Care Services Division Department of Dental Services Brunei Darussalam 27.08.2013
OUTLINE OF PRESENTATION
Country Profile Vision & Mission Organization structure & Workforce Oral health status Quality of Dental services:
– Patient safety – Effectiveness – Patient centeredness – Timeliness – Efficiency – Equity
COUNTRY PROFILE
Land area = 5,765 km 2 Capital City: Bandar Seri Begawan 4 districts: Brunei Muara (housing the capital city), Tutong, Belait & Temburong
Population = 393,162 (2011 census)
Brunei Muara = 279,842
Belait = 60,609
Tutong = 43,855
Temburong = 8,856
GDP per capita = B $53,000 (2012) ≈ US $41,340
VISION
• Together towards a Healthy Nation
MISSION
• To improve Oral Health through effective,
equitable, affordable, accessible, safe & sustainable Oral Health Care in Brunei Darussalam AIM
• Healthy Mouth, Healthy Nation
ORGANIZATION STRUCTURE
81 Dentists 52 locals : 29 non-locals 104 Dental Nurses 102 locals : 2 non-locals 37 Dental Technologists/Technicians 36 locals : 1 non-locals 88 Dental Assistants TOTAL DENTAL WORKFORCE= 352 41 Administrative Staff
ORAL HEALTH STATUS
National OH Survey 1999 5 - 6 years old % caries free 11.3
dmft 7.1
10 - 12 years old % caries free 12.9
DMFT 4.82
13 - 15 years old % caries free DMFT 5.8
7.24
35 - 44 years old % caries free 1.7
DMFT 14.4
CPITN Score 0 (Healthy periodontium) 1 (Bleeding on probing) 2 (Presence of calculus) 3 (Pockets 4 – 5 mm) 4 (Pockets 6 mm or more) % of 10 – 12 years old 1.3
76.4
86.4
N/A N/A % of 13 – 15 years old 0.7
75.7
87 5.1
0 % of 35 – 44 years old 0 43.4
85.7
65.4
20.6
Quality of Dental services
PATIENT SAFETY
Health & Safety Division established in 2011
– Infection Control Unit – Fire Safety Unit – Radiation Protection Unit – Medical Emergency Unit – Hazardous Waste Disposal Unit – First Aid Unit – Occupational Health Unit
INFECTION CONTROL UNIT
Promote & implement excellence
Increase awareness & ensure adequate training
Update infection control protocol with latest guidelines every 2 years
FIRE SAFETY UNIT
Prevent or minimise fire by:
– Use of detection & extinguishing
systems
– Adequate fire fighting services – Training in fire safety & evacuation
procedures
– Regular inspection & maintenance of
detectors & fire extinguishers
RADIATION PROTECTION UNIT
Ensure consistently adequate diagnostic information
Supervise radiation quality standards & assurance programme
Ensure staffs are properly trained
Undergo periodic examination & testing of engineering controls, design & safety feature
Provide contingency plans & conduct any investigations following an incident or accident situation
MEDICAL EMERGENCY UNIT
Training in management of medical emergencies
Equip all clinics with medical emergency equipment & drugs
Ensure all equipment & drugs are regularly maintained & monitored
Audit all medical emergency cases
HAZARDOUS WASTE DISPOSAL UNIT
Provide a minimum standard for safe & efficient healthcare waste management
Guidelines for healthcare waste management in dental clinics & school dental services
Periodically update guidelines in line with internationally-accepted guidelines
Monitor waste management by performing clinical audits
FIRST AID UNIT
Provision of first-aid care to all staff & patients as may be required during emergencies
Arrangement of prompt & appropriate referral to medical aid if required
Prompt notification of injuries/incidents to Health & Safety Division
Regular monitoring of first aid equipment
OCCUPATIONAL HEALTH UNIT
Maintain & promote staff’s health & working capacity through education
Improve & upgrade working environment, so it is conducive to a safe & healthy place to work
EFFECTIVENESS
Provide various forms of comprehensive dental services Primary Oral Care Services
Orthodontic Prosthodontic Endodontic Oral Surgery Periodontic Pedodontic Restorative (Implants) Specialist Care Services Quality of Dental services School Dental Services Dental Laboratory Services
SCHOOL DENTAL SERVICES
Provide appropriate preventive & curative oral health care to all schoolchildren Promote oral health of schoolchildren
Daily Fluoride Tooth-brushing programme & activities in collaboration with School Authorities Health Promoting School programmes in collaboration with Ministry of Education
4,9 dmft 5-yr-olds DMFT 12-yr-olds 4,7 4 4 2,9 5,3 1,2 0,8 0,7 0,6 2008 2009 2010 YEAR 2011 2012 Changing levels of mean dmft among 5-year-olds schoolchildren and mean DMFT among 12-year-olds schoolchildren for whole state (2008-2012)
ORAL HEALTH PROMOTION PROGRAMS
Water fluoridation
Water samples monitored by MOH & Public Works Department WATER PLANT Layong Bukit Barun Seria Mengkabau Temburong FLUORIDATION YEAR 1987 1996 2000 2000 2008 98% receives fluoridated water
ORAL HEALTH PROMOTION
Antenatal Oral Health Care Programme Parents & Toddlers Programme in Health Clinics Toddlers, Rolling Toothpaste & Fluoride Varnish Programme
9 months old children given a bag with toothbrush, toothpaste, feeder cup & oral health promotion information
Followed up & given toothbrush + toothpaste every 6 months 5 years old
Fluoride varnish applied to children’s primary teeth from 2-5 years old 2x a year
ORAL HEALTH PROMOTION
Daily Fluoridated Tooth-brushing Programme in Schools
Polly paste, imported from Philippines & F tested in ACTA Netherlands Germany (1,450ppm) Fluoride Varnish Programme
Apply fluoride varnish to all Primary 1 children, twice a year Oral health Awareness Programme in Primary Schools, Secondary Schools & Community
ORAL HEALTH PROMOTION
Media Program
TV promo , TV & Radio interview
Interactive CD in collaboration with Institute of Technology, Brunei Darussalam
Dental Song Competition in 2012
CLINICAL AUDIT DIVISION
Established in 2011
– To improve quality of clinical care by
creating a culture committed to learning through systematic review of care
– Implementation of methods for
improvement is then based on evidence relevant to our local situation rather than just opinions
CONTINUING PROFESSIONAL DEVELOPMENT UNIT
Provide & oversee CPD activities
All Dentists & Nurses must maintain CPD logbooks annually
Minimum 30 CPD points per year verified by CPD unit (1 lecture=1 point) Other Dental Staff: 100 hours annually from Continuing Professional Development Programmes or Activities
RESEARCH & DEVELOPMENT DIVISION
Provide accurate, effective & timely oral health statistical data
Promote evidence-based policy making
ANNUAL APPRAISAL FORM
For all Civil Servants Criteria
– Work knowledge – Attendance timeliness – Work management – Decision-making – Innovativeness – Communication – Reliability – Leadership – Commitment
Rewarded with annual bonus
– Grade A-D = 100% bonus – Grade E = 50% bonus – Grade F = 0% bonus
PATIENT CENTEREDNESS
Quality of Dental services
Customer Care Unit
– Handle patients’ complaints – Incident reporting forms available – A survey of patients satisfaction regarding
dental services provided by Primary Oral Care in Brunei Darussalam (2011)
293 participants
Questionnaire includes: services provided, waiting time, facilities & suggestions for improvement
OVERALL SATISFACTION ON THE SERVICES PROVIDED
OVERALL SATISFACTION ON WAITING TIME
OVERALL SATISFACTION ON THE FACILITIES PROVIDED
SUGGESTIONS FOR IMPROVEMENTS
4 % 3.8 % 3 % 1.4 %
TIMELINESS
Quality of Dental services
Adult Outpatient registration times
– 7:45 A.M. – 10:00 A.M
Children Outpatient registration times
– 7:45 A.M. – 10:00 A.M & 1:30 P.M. – 3:00 P.M
Emergency service (on-call after-office hours) at all major hospitals (A&E department) Audit done
– Waiting time of patients attending Adult Dental
Outpatient Services in National Dental Centre during off-peak & peak periods in June 2012
AVERAGE WAITING TIME BETWEEN TAKING QUEUE NUMBER & REGISTRATION, & BETWEEN REGISTRATIONS & FIRST CALLED BY DENTAL SURGERY ASSISTANT (DSA)
COMPUTERIZED RECORDS
Bru-HIMS ( Brunei Darussalam Healthcare Information & Management System) launched in Tutong District in 2011
Expected to be fully operational in all 4 districts by 2014
Main objective of BRU-HIMS system
– To help improve quality of medical care
Computerized records will help reduce registration time
REFERRALS TO SPECIALIST CARE
Prompt referral for Emergency cases
Waiting list
– Orthodontic Unit: 4 years – Prosthodontic Unit: 6 months – Endodontic Unit: 4 months – Oral Surgery: 3 weeks – Periodontic: 3 months – Pedodontic & Restorative (Implants): Nil
EFFICIENCY
Quality of Dental services
In 2002, His Majesty the Sultan of Brunei Darussalam urged all Ministries & Departments to produce ‘Work Procedure Manual’ (Standard Operating Procedures) to improve civil service
FINANCE UNIT
Ensure delivery of services is efficiently carried out by having all consumables, instruments & equipment readily available at all time
BIOMEDICAL ENGINEERING UNIT
Advice on equipment safety hazards, equipment compatibility & quality of equipment Preventive maintenance & breakdown repair of dental equipment Equipment commissioning & acceptance test for new dental equipment Replace unreliable & obsolete equipment & provide technical report for equipment write-off Preventive Maintenance Contract of Dental Chairs & Equipment with Local Dental Supplier
DENTAL HYGIENE & THERAPY TRAINING PROGRAM
Cost-efficient workforce development strategy
– More expensive to train Dentists – Poor recruitment for Bachelor of Dental Surgery
Train dual qualified Dental Hygienists/ Therapists who can provide primary dental care & dental health education to children & adults Provide ‘top-up’ course to expand scope of work of existing Dental Nurses
VARIOUS COMMITTEES
Procurement In-Service Training Disciplinary Recruitment Promotion Write-off Welfare
EQUITY
Quality of Dental services
Primary Oral Care Services
– 21 dental clinics throughout the country
Specialist Care Services
– Full-time in Brunei-Muara: All – Full-time in Tutong: Orthodontic – Part-time in Tutong: Paedodontic & Oral Surgery – Full-time in Belait: Paedodontic, Oral Surgery,
Orthodontic
– Part-time in Belait: Prosthodontic, Endodontic &
Periodontic
Bunut HC (1,709) Sengkurong HC (56,017) Jerudong Prison (240) Pengkalan Batu HC (13,031) PMMPHAMB Hospital (33,400) Mata-Mata HC (6,699) Police HC (3,240) National Dental Centre (60,347) Rimba HC (63,621) Sg. Hanching HC (41,117) Sungai Besar HC (1,917) Muara HC (25,462) Subok HC (2,732) RIPAS Hospital Sg. Liang HC (12,760) Telisai HC (7,068) Sg. Assam HC (20,247) PIHM Hospital (8,856) SSB Hospital (33,067) Seria HC (13,093) Labi HC (1,426) Lamunin HC (10,720) Legends : National Dental Centre Dental Clinic in Health Centre (Full-Time) Dental Clinic in Health Centre (Part Hospital-based Dental Clinic
PAEDODONTIC UNIT
Provide specialised & comprehensive dental care for children with special needs & medically compromised Provide preventive programme & oral health education to both children with special needs & their carers
SCHEME OF CHARGES
OUT-PATIENT – ATTENDANCE FEES
Registration Fee :
Citizens = $1.00
Government Servants & Permanent Residents = $3.00
Others = $5.00
EXAMPLE
FINAL NOTE
Challenges to ensure/monitor quality
– Insufficient workforce
Dentists play multiple roles
– Workforce recruitment & retention – Limited room/facilities for expansion – High burden of oral diseases – High demand for treatment – Lower priority for prevention – Procurement of dental supplies
@ Department of Dental Services, Brunei Darussalam