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704 / Diagnostic- therapeutic pathways for BRONJ prevention and treatment

ITALY
Classification of the PSP
Type of Patient Safety Practice Safe
 
Clinical Practice (CP)
Related practices from PaSQ database
"Best fit" category of the reported practice
Other
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Topic of the reported practice
Clinical guidelines or pathways
Aim and the benefit of the Patient Safety Practice
 
The therapeutic management of BRONJ (Bisphosphonates-Related Osteonecrosis of the Jaws) includes medical therapy with applications and repeated rinses with antiseptics associated with antibiotic therapy, and , in combination with antibiotics and topical antiseptics, different surgical therapies in terms of intervention and anesthesia (local or general).
Recently it has been noted that the application of the laser at low energies with its bio-stimulating effect on soft tissue and bone, and ozone can enhance the action of the medical therapy alone or medical and surgical therapy. The experience developed at the U.O. Odontostomatology of the Hospital-University of Parma would identify the indication for surgical treatment, possibly laser-assisted, already in the early stages of BRONJ (Stage I) with prognostically favorable results in the context of minimally invasive surgery, surgery, in fact, in this context, it is feasible outpatient under local anesthesia, avoiding the need for major surgery during hospitalization and general anesthesia.
Description of the Patient Safety Practice
 
Based on the experience of the U.O. Odontostomatology of the Hospital-University of Parma, started in 2004, and on the Recommendation N.10, 2009, of the Italian Ministry of Health on the "Prevention of osteonecrosis of the jaws related to bisphosphonates therapy") a clinical pathway (PDTA) supported by SSD. Clinical Governance Risk Management, shared with the U.O. Odontostomatology, Medical Oncology, Maxillo-facial surgery, Hematology, Clinical and Laboratory Medicine, Pathology, Radiological Sciences, Pharmacy Service has been prepared. The clinical pathway provides specific forms including: information sheet for the patient, informed consent, document reporting suspected adverse drug reaction (ADR), letter to the physician (general practitioner), dental care document for patient undergoing bisphosphonate therapy or already under bisphosphonate therapy that allows the interaction between dentist and other specialists in order to follow the patient during its course. Monitoring showed that 43 patients out of 191 patients treated underwent therapeutic protocols as a result of early diagnosis of BRONJ (stage 1) reaching complete recovery in the almost totality of cases (86%). A coordinated approach to the patient contributes to a correct prevention with consequent reduction of cases of osteonecrosis of the jaw, to an early diagnosis of BRONJ, with limitation of the more invasive interventions, while avoiding hospitalizations and interventions under general anesthesia with a consequent reduction of costs incurred.
http://buonepratiche.agenas.it/practicesdetail.aspx?id=3505
Attachment of relevant written information and/or photos, as appropriate
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Effectiveness of the Patient Safety Practice
 
Degree of implementation of reported practice
Yes, fully
Level of implementation of reported practice
Institution level
Specific and measurable outcome for the reported practice were defined
Yes
A baseline measurement before implementation of the reported practice was obtained
Yes
A measurement after full implementation of the reported practice was obtained
Yes
Evaluation of a "positive" effect of the reported practice on Patient Safety
The evaluation showed improvements in Patient Safety outcomes
Type of before-and after evaluation
Quantitative
Enclosure of a reference or attachment in case of published evaluation's results
There is no specified text here
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Health care context where the Patient Safety Practices was implemented
 
Hospital
Transferability
 
Successful implementation of this Patient Safety Practice in other health care settings than above stated
Not known
Specification of implementation in another health care setting(s)
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Successful implementation's level  of this Patient Safety Practice across settings
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Involved health care staff
 
Other member of the dental team (dental assistant, dental hygienist, dental technician, dental therapist etc.) or dental technicians
Risk manager
Patient Involvement
 
Direct service user's involvement as integral part of this Patient Safety Practice
Yes
Specification of the service users or their representatives' involvement in the implementation of this Patient Safety Practice
Patient(s)
Point of time in which service user or their reprasentatives' involvement takes place
During implementation of the Patient Safety Practices
Active seeking of service users' opinion, feedback, experience, etc. as integral part of this Patient Safety Practice
Not known
Short description of the service users' level of involvement
Not known
Public accessibility of information regarding this Patient Safety Practice to patients and citizens/service users
Yes
List of sources where public information is accessible
http://buonepratiche.agenas.it/practicesdetail.aspx
Implementation of the Patient Safety Practice
 
Existing collaboration with other countries or international organisations related to implementation of this Patient Safety Practice
No
Problems encountering in the implememntation course of this Patient Safety Practice like lack of motivation, no management support, etc.
No
List of the most prevelent difficulties encuntered during implementation of this Patient Safety Practice
There is no specified text here
List of the most prevalent drivers for a successful implemetation of this Patient Safety Practice
Other
Use of any specific incentives to enhance motivation while implementing this Patient Safety Practice
No
Description of used incentives, if any.
There is no specified text here
Existence of support or approval by the clinical or hospital management or any other hihg level authority in the implementation process of this Patient Safety Practice
Yes
Costs of the Patient Safety Practices
 
Completion of cost calculation related to this Patient Safety Practice
No
Total number of person days required to implement this Patient Safety Practice
Clinical staff: There is no specified text here
External consultants: There is no specified text here
Support staff: There is no specified text here
Managerial staff: There is no specified text here
Others: There is no specified text here
Not relevant: There is no specified text here
Total number of person days required for training as preparation for implementation of this Patient Safety Practice
Clinical staff: There is no specified text here
External consultants: There is no specified text here
Support staff: There is no specified text here
Managerial staff: There is no specified text here
Others: There is no specified text here
Not relevant: There is no specified text here
Total cost in Euro of specific equipment (machines, software, communications supplies, etc.) needed to support implementation of this Patient Safety Practice
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Associated cost with a work reduction or foregoing in order to deliver this Patient Safety Practice
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Contact information
 
Name: G.CAMPANIELLO, G.RAISE
Country: ITALY
Organisation: AZIENDA OSPEDALIERA DI PARMA
E-mail: gcampaniello@ao.pr.it; graise@ao.pr.it
Phone: 0521702451
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