Oral Health Group
Feature

Keep Calm & ADPIE: Unleashing Hygienists’ Potential

May 12, 2020
by Tracy Poirier, RDH, IMC™


Did you know that acronyms are actually very modern inventions? They were found to be in existence around World War 1, but were still not used very much until World War 2. The word “acronym” did not even come into play until 1943 because they simply were not used in daily life like they are now. Once the U.S. Space Program and the Cold War started using them, a dictionary of acronyms ended up being published in 1960 with over 12,000 entries.

Why am I offering you a little history lesson? Since acronyms are used every day, I was honestly curious about their origin and there is one in particular that dental hygienists need to live by, at least in their clinical practice.

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The acronym I am referring to is ADPIE, which refers to the Dental Hygiene Process of Care:

Assessment | Diagnosis | Planning | Implementation | Evaluation

In 2016, The College of Dental Hygienists of Ontario (CDHO) published an article about The Dental Hygiene Process of Care. The following is a quote from that article:

“Best practice indicates that the Dental Hygiene Process of Care (ADPIE) is the framework within which all dental hygiene therapy should be conducted.”

I decided to do a little more research and comb through the dozens of governing bodies and associations across Canada for any differences in standard of care and responsibilities of dental professionals and here’s what I learned: no matter what province we live in, our regulatory bodies and associations are all sharing the same message. Dental hygienists have a legal and ethical responsibility to ensure that ADPIE is the key to standard of care for each client.

The question we need to ask ourselves is this: How well are we doing with keeping calm and ADPIE?

We are probably doing okay in the keeping calm part, but my research uncovered some statistics that says ADPIE might be something we need to improve on.

The reality is that the implementation of “standard of care” is still an ongoing issue here in Ontario. The CDHO publishes the top discrepancies after reviewing the Quality Assurance Portfolios annually. Top of the list in 2010 was the failure to perform complete and comprehensive periodontal exams. On that same list was the failure to perform ongoing periodontal re-evaluations. In checking with the CDHO now 10 years later, this still rings true.

This means that the assessment portion, which includes the comprehensive periodontal exam, is only being partially completed or not at all. Since we know that a diagnosis is evidence-based, how are we obtaining that diagnosis without comprehensive charting?

The good news is that Canada is among the world leaders when it comes to the overall oral health of its citizens since oral health is recognized as a basic human right. However, as many as one out of two Canadians (that’s 16 Million Canadians young and old) have gingivitis and don’t even know it. It’s something that could lead to tooth loss if left to progress and yet is completely curable. In fact, an estimated 20 percent of Canadians are still unaware that they have active periodontal disease.

Did you know that oral diseases account for productivity losses of over one billion per year in Canada alone? That is a staggering statistic!

Now, more than ever, with the world having come undone and now slowly starting to rebuild through the COVID-19 pandemic, it’s going to be essential for dental professionals to apply this system purposefully and to its fullest extent when the time comes to getting back to being able to serve.

If there was ever a time to get serious about initiating a solid periodontal program this is it. Otherwise we will continue to unconsciously be a part of what I refer to as the “perfect storm,” where well-intentioned, good dental hygienists, who had the dream to make a difference, over the course of time, may have lost their motivation for a variety of reasons. And the systems that were in place start to fall apart when that motivation is lost.

I get it! As a 30-year veteran of dental hygiene, I have certainly lost my motivation along the way at times. It’s tough to show up every day, unpack the challenging pieces of our life at the door of the practice and be at our best. Not to mention that “being at our best” when life is going well is very different from “being our best” when life is not going well. We have to honour and accept our capabilities in that moment.

However, we do not have any leniency when it comes to our ethical responsibility within this system despite tight time frames, treatment mix and, of course, things that are out of our control. What choices do we actually have?

One choice is to fully understand where we are currently within our clinical practice–where we are solid and where are we wobbly and in need of support. We can choose to look at it with fresh eyes and new perspectives and make moves that might allow you to incorporate this more fully when you all get back into your practices.

There are four questions you can ask yourself to understand your current position within ADPIE.

First keep calm and take a breath. Then ask:

  1. Are my current beliefs, thoughts or old patterns, leading me towards being intentional with ADPIE?
  2. Are my current actions leading me to being intentional with ADPIE?
  3. Are my current relationships with my leader(s), colleagues, team members and with myself guiding me towards being intentional with ADPIE?
  4. Are my current instruments, systems, operatory environment(s) leading me to being intentional with ADPIE?

After reading through those questions, do you have a sense of (if anything) that needs to be addressed to serve your clients?

Breathe again. Because now we’ll review the basics of the process. I am only highlighting the main areas in this article. Please refer to the links added at the end for further reference and additional information.

ADPIE: The Dental Hygiene Process of Care

A – for Assement
D – for Diagnosis
P – for Planning
I – for Implementation
E – for Evaluation

Assessment
The collection and analysis of systematic and oral health data in order to identify client needs.

  1. Health History
  2. Clinical Assessment
  3. Risk Assessment

Diagnosis
The dental hygiene diagnosis re-quires evidence-based critical analysis and interpretation of assessments in order to reach conclusions about the patient’s dental hygiene treatment needs.

Planning
Planning is the establishment of realistic goals and the selection of dental hygiene interventions that can move the client closer to optimal oral health. The interventions should support overall patient goals and oral health outcomes.

The dental hygiene care plan should be:

  • Safe
  • Evidence-based
  • Clinically sound
  • High quality
  • Equitable

There are 5 steps within the dental hygiene treatment plan for each client:

  1. A complete clinical assessment
  2. A dental hygiene diagnosis
  3. Client-centred goals/objectives
  4. Planned sequence of activities
  5. Client participation

Implementation 
Implementation is the act of carrying out the dental hygiene plan of care.

Care should be delivered in a manner that:

  • Minimizes risk
  • Optimizes oral health
  • Recognizes issues related to patient comfort including pain, fear, and/or anxiety.

Evaluation
Evaluation is the measurement of the extent to which the client has achieved the goals specified in the dental hygiene care plan. We once again use evidence-based decisions to continue, discontinue, or modify the care plan based on the ongoing reassessments and subsequent diagnoses.

Breathe. Do you feel solid within the framework of ADPIE? If so, I applaud you and hope that you continue to serve from that foundation.

Do you feel wobbly in some places? If so, I applaud you for being honest with yourself about where you might need support to once again serve from that foundation.

What’s the next step? In the words of Mark Twain, “The secret of getting ahead is getting started. The secret of getting started is breaking your complex, overwhelming tasks into small manageable tasks, and then starting on the first one.”

Resources


About the Author

Tracy Poirier, RDH, IMC™ began her journey as a dental assistant and then she spent almost 30 years as a dental hygienist in both general and periodontal practice. In 2016 she obtained a certification as an Integral Master Coach™ which allows her a unique perspective and approach in the world of dentistry. Her passion is to coach, motivate and inspire dentists and dental hygienists to show up as their best selves personally and in professional practice. She started writing in 2018 and has since become a published author in several dental publications. She is also a proud member of the Healthy and Respectful Workplace Advisory Committee with The Canadian Dental Hygiene Association. Tracy can be reached at tracynjpoirier@gmail.com


To see more from the 2020 May issue of Oral Hygiene, please click here.