Audit to assess the clinical computer standards of the student restorative clinic in the University of Manchester dental hospital
Introduction: The use of computers in clinics is a useful tool for clinicians, however it can create challenges for their users with regards to cross infection control and patient data protection. The GDC (General Dental Council) and CMFT (Central Manchester Foundation Trust) have set standards for cross infection control and handling patient data. These standards were used to assess the clinical computer use on the ground floor restorative clinic in the University of Manchester dental hospital. Method: Clinical computers were assessed and data collected over the period of two weeks on Mondays, Wednesdays and Fridays. The computers were assessed using a data collection sheet. Results were compiled and analysed. Results: 89% of computers met the standards for data protection, 57% of the computers met the standards for cross infection control. Conclusion: The results show that standards for cross infection control for the computers on the clinic were particularly poor. They also showed that standards for data protection are not being met by some users of computers in the clinic. Action plan: Students and staff on the student restorative clinic should be made aware of results and recommendations should be implemented. A repeat audit should be undertaken in 12 months to monitor any improvement.
Background
The use of clinical computers in the dental hospital has a significant role in patient care. With the introduction of software to handle patient notes being introduced in September 2014 this is even more relevant than ever before. Now that students use the computers to record all their clinical notes, there is a larger amount of patient data being stored on them and the computers are being used much more frequently.
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Whilst the use of computers for clinical purposes can be a useful tool for clinicians, it also poses new challenges to those using them. Personal information of patients should be protected at all times and this means storing records securely where they will not be seen by other patients, unauthorised healthcare staff or members of the public (GDC, 2005) . Appropriate cross infection control should also be maintained when using computers on clinic. Cross infection control precautions are necessary to ensure the safety of patients and healthcare personnel (NHS, 2010). Therefore staff and students need to be aware of the proper procedures to follow when using the computers as part of their clinical practices.
The clinical computers on the ground floor restorative clinics are situated within the clinical bays and are accessible to students and staff during and after treatment. Access to these computers is restricted through a password log-in providing they have been logged out of. Many of these computers have patient data freely accessible once the computers have been logged into. Currently there is no specific instruction to students to log out of the machines after use.
The computers on the clinic use a conventional keyboard and mouse to operate. This creates a potential problem for cross infection as the computers are often used during treatment of patients.
Aims and objectives
The aim of this audit is to ensure that CMFT and GDC standards for cross infection control and patient confidentiality are adhered to in the dental hospital ground floor clinic with respect to clinical computer use.
The objective of this audit is to assess the quality of cross infection control procedures and patient confidentiality with regards to clinical computer use and to devise implementations which can be made to improve practices and meet the standards set.
Standards
In order to assess the use of the clinical computers within the restorative clinic I have used policies and standards set by the CMFT and GDC Nationally.
The CMFT have policies on cross infection and patient data protection available here:
http://www.cmft.nhs.uk/your-trust/freedom-of-information/our-policies-and-procedures
The policy document ‘Records Management: NHS Code of Practice’ outlines that equipment used to store records should provide storage that is safe and secure from unauthorised access and which meets health and safety regulations.
The NHS policy document ‘standard infection control precautions’ provides guidance for the proper cross infection control procedures for care equipment available:
The General dental council also has set standards for all dental professionals to follow and has a document available which outlines the need for patient confidentiality and the responsibility of dental professionals to maintain it.
http://www.gdc-uk.org/Dentalprofessionals/Standards/Documents/PatientConfidentiality[1].pdf
All students and staff using clinical computers should meet these standards.
Method
- The audit was carried out retrospectively.
- A total of 45 Computers on the ground floor restorative clinic were assessed on Monday, Wednesday and Friday afternoon for 2 weeks.
- Computers were assessed using a data collection sheet (appendix 1).
- Data from the collection sheet was compiled and analysed.
The data collection sheet gathered information for the following categories:
- Cross infection control
Computer hardware which must be touched for use i.e. Keyboards and mice were checked for appropriate barrier guard protection and cross infection control procedures. Computer keyboards must have barrier protection as appropriate cross infection control cannot be achieved by wiping with disinfectant due to the structure of the keyboards being used. The mice which are used can be wiped and so students were asked if they had wiped the mouse after use. Students were also asked if they had wiped the plastic cover of the keyboards. Keyboards which did not have barrier protection and those which did and were not wiped were deemed to not meet the standards of the CMFT. Mice which were not wiped with disinfectant were also deemed to not meet the standards of the CMFT.
- Data protection
Computers were assessed to see if the users had logged off after use. Computers were also assessed to see if there was personally identifiable patient data accessible without restriction. Any computers with unrestricted patient data were deemed to not meet the standards set by the GDC and CMFT.
Results
The results from the collection sheet from all 6 days were compiled to give an average over the two weeks which were converted into percentages represented in the graphs below.
- Cross Infection Control
This graph shows the percentage of the computers which had a plastic barrier guard protection over the keyboard at the end of the sessions. From the data collected an average of 24% of computers in the ground floor restorative clinic had no barrier protection during the clinical sessions. Of the computers which had barrier protection I asked the students from these bays if they had wiped the plastic barrier guard with disinfectant, the results are shown below.
The graph shows that on average over the two weeks 18% of the keyboards with barrier protection were not wiped with disinfectant at the end of the clinical session.
All of the mice for the clinical computers in ground floor restorative have no barrier protection and so students were asked if they had wiped the mice at the end of the session, the results of which are shown below.
The data collected showed that on average over the two weeks 21% of students had not wiped down the mice with disinfectant after using them.
Computers which did not have barrier protection for the keyboard and those which did but were not wiped as well as those with mice that weren’t wiped were considered to have inappropriate cross infection control. The total results represented as a percentage in the chart below.
The data collected showed that in total 43% of computers being used in the ground floor restorative clinic were not meeting CMFT standards for cross infection control.
- Data Protection
This graph shows the percentage of computers which were logged out of at the end of the clinical sessions over the two weeks. The data collected shows that 52% of computers on ground floor restorative were not logged out of at the end of the session creating a potential data protection issue.
Computers were also assessed to see if any personally identifiable patient data was freely accessible without restriction, results shown as a percentage in the graph below.
The data collected showed that 11% of the computers on ground floor restorative clinic had personally identifiable patient data freely accessible without restriction and thus these computers were deemed to be unsecure in terms of patient data protection. Therefore these computers do not meet the standards set by the CMFT and GDC for patient confidentiality.
Conclusion
Using the guidelines set by the CMFT and GDC I have assessed the clinical computer standards of the ground floor restorative clinic with regards to cross infection control and data protection of patients. The results show that only 57% of computers in the ground floor restorative clinic meet the standards of cross infection control. This was mostly due to barrier guards on keyboards not being used but it was also the case that students were not using disinfectant wipes on both the keyboards and mice. 89% of the computers meet the standards for data protection. The remaining 11% was a result of patient data being accessible directly from logged in machines thus the information was not secured. The results show that there is significant improvement to be made in the practices of staff and students using the computers on clinic to better protect patient confidentiality and wellbeing. Therefore action should be taken and recommendations implemented to improve the clinical computer standards of the clinic.
Recommendations and action plan
The results of this audit should be discussed with students who use the ground floor restorative clinic. It would also be useful to discuss the results with clinical tutors and other healthcare staff on clinic who oversee work done by students and who also sometimes use the computers.
The clinical induction period for students at the start of the year would be an appropriate time to give specific instruction to students regarding clinical computer use.
The instruction should highlight the correct cross infection control procedures for the computers including mandatory use of a barrier guard for keyboards and use of disinfectant wiped for both the keyboard barrier and mice. This could be included with other cross infection control inductions such as hand washing and usage of the clinical units.
Instruction should also be given to students to log out of machines after use. If 100% of student implement this recommendation then data protection issues regarding the clinical computers would be largely resolved.
The audit should be repeated in 12 months’ time to investigate any if any improvements have been made following implementation of recommendations. This allows time for the yearly clinical induction for students to have taken place.
References
- GDC 2005. General Dental Council. Standards Guidance. Principals of patient confidentiality. Available:
http://www.gdc-uk.org/Dentalprofessionals/Standards/Documents/PatientConfidentiality[1].pdf
- NHS 2010. NHS Professionals. Standard infection control precautions. Available:
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