Patient safety, risk management and quality improvement
Safety systems, not blame
Patient safety rests on reporting, learning and system design. Report incidents and near misses through your service's system, take part in open disclosure when harm occurs (consistent with Right 6 and Health and Disability Commissioner guidance), and use clinical audit, consumer feedback and PDSA cycles to improve care. Check emergency equipment and drugs each shift: oxygen, suction, bag-valve-mask, adrenaline, salbutamol, glucose, and a defibrillator where available.
High-risk calculations
Local anaesthetic toxicity is dose-related. Lidocaine 2% with adrenaline contains 20 mg/mL, so a 1.8 mL cartridge holds 36 mg. The maximum dose is 4.4 mg/kg (absolute maximum 300 mg).
Worked example
A 20 kg child needs local anaesthetic. Maximum dose = 20 × 4.4 = 88 mg. 88 ÷ 20 mg/mL = 4.4 mL, which is about 2.4 cartridges. You calculate and record the volume before starting, use aspiration, and stop if the child becomes drowsy or agitated.
Quality improvement
Choose a measurable problem (for example, incomplete caries risk documentation), audit a sample, change one thing, re-audit. Radiation safety, infection control auditing, cold-chain and expiry checks, and correct patient identification are all part of the same system.
Traps
Not reporting near misses; blaming an individual instead of the system; using expired adrenaline; guessing paediatric doses; failing to document the disclosure conversation.