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Improving Adherence to Fluoride Varnish Application Guidelines: A Quality Improvement (QI) Study

Sareema Adnan, Gabriela Zambrano-Hill

University of Texas Medical Branch


Introduction: Tooth decay is the most prevalent preventable disease impacting pediatric patients, affecting 60-90% of schoolchildren worldwide. Dental disease in early childhood predicts poor oral health and chronic morbidities that continue into adulthood. Fluoride varnish application significantly reduces the incidence of dental decay in children, most notably in high-risk and vulnerable populations. The United States Preventive Services Task Force and American Academy of Pediatrics guidelines recommend that primary care physicians routinely apply fluoride varnish from the age of tooth eruption through the age of five years.

Methods: Root cause analysis of barriers to standardized documentation in a primary care pediatric clinic revealed that resident training and documentation should be altered. Training was given that emphasized the importance of documentation for purposes of data collection and clinical revenue for ability to bill for these services. In order to measure and improve the rate of guideline adherence at the encounter level, an intervention was built into the electronic medical record (EMR) that adds dental health and fluoride varnish application into the standard documentation template for every well child visit. Adherence rate to application guidelines and rate of proper documentation was assessed at set intervals via chart review and utilization of EMR functionality.

Results: In the initial cycle of the QI project, rates of fluoride varnish application increased from 28 % to 55% in the three-week period following on-site resident training and posting of visual protocol reminders. The results of a further three week period are being collected.

Conclusion: Current recommendations based on previous data collection is to standardize electronic medical record recording procedures and educate residents on fluoride varnish importance in order to increased adherence to fluoride varnish application guidelines.

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