Online Learning Plan & Documentation Webinar FAQs

Root of the Matter: Webinar FAQs

Jacqueline Guyader, Senior Dental Hygiene Advisor
Melissa Mollberg, Dental Hygiene Advisor

CDHBC staff have been involved in presenting two separate information webinars for registrants on several occasions over the previous six months.  The Practice Standards and Clinical Documentation webinar incorporated information, scenarios, and questions related to the required documentation practice standards.  The Online Learning Plan (OLP) webinar focused on the steps a registrant would take once they have completed the QAP Assessment Tool; this webinar had a specific focus on the development of SMART learning goals, action plans to meet the learning goals, and developing a meaningful reflection on the learning that occurred.  
The webinar format allowed time for questions and answers at the end of each interactive presentation. The presenters noted some common themes in the questions posed by various registrants during the initial webinar sessions, which were repeated in the subsequent webinar presentations. In light of this, the CDHBC decided to publish a Frequently Asked Questions (FAQ) section in the Summer 2015 issue of Access in order to share the information with all CDHBC registrants.   

Online Learning Plan Webinar Questions:

Do we only need to create learning goals for the guided learning plan, or do we need to create learning goals for the self-directed plan as well?

The QAP Assessment Tool provides feedback on what is measured as the lowest scoring content subcategories; these are automatically identified and included in the Guided Learning Plan (GLP) section of the Online Learning Plan (OLP). Registrants are required to consider and use this feedback to create learning goals to improve knowledge in the identified subcategory. Learning goals in the guided learning plan are required areas of learning.  

Self-directed Learning Plans (SDLP) are determined and completed by registrants at their discretion. Learning goals for the self-directed learning plan are entirely for the personal and professional benefit of registrants’ ongoing professional development. It should be noted that the College encourages registrants to develop learning goals as part of their ongoing commitment to life-long learning and quality assurance when completing their Self-Directed Learning Plan. 

Are registrants allowed to receive CE credits for any learning activity, such as reading a text book or dental hygiene journal? Does a QAP reflection template form need to be completed if you read a chapter from a DH text book?

Provided that the learning activity in question applies to the professional learning of the dental hygienist (as opposed to leisure activities such as yoga or meditation – these are not acceptable for credit), as well as applying to the individual hygienist’s practice setting, continuing competency credits may be applied to one’s guided or self-directed learning plan.  For those who have not yet entered a QAP cycle, credits may be applied towards one’s continuing competency requirements. 

An overview of QAP Learning Activities can be accessed on the CDHBC website.  It is important to note that some activities have limitations and/or additional requirements.  For example, reading a journal article or a chapter in a dental hygiene textbook has a maximum allowance of 25 credits per cycle, as well as the additional requirement to complete a reflection. A QAP Reflection Template has been developed for use to facilitate the reflection process. 

Once my QAP Assessment tool results have populated my Online Learning Plan, how many SMART learning goals per sub-category is considered appropriate? 

There is no specific requirement for the number of SMART learning goals that need to be developed in order to meet an identified required content sub-category.  The rule of thumb is that there should be at least one SMART learning goal developed for each content sub-category.  However, if the learning goal becomes too complex, it would be appropriate to break the one learning goal into several smaller more achievable learning goals.   

For example, Dental Sciences – radiology knowledge and interpretation may have been identified as a learning need based on the results of the QAP assessment tool.  The registrant, using their professional judgment, knows they want to work on horizontal angulation when exposing bitewing radiographs due to recent overlaps on bitewing radiographs they exposed. The registrant identified the need to re-familiarize themselves with periodontal structures on the radiograph exposure, such as the periodontal ligament space, lamina dura, and alveolar crest changes. These two components of the learning goal both fall within the identified content sub-category; however, they will be comprised of separate learning activities. Therefore it would be appropriate to develop two separate learning goals for this content sub-category. 

Is there a minimum number of credits that should be applied towards each learning goal?

There is no specific requirement placed on the amount of credits that should be applied towards each learning goal.  It is up to the professional judgment of the registrant to determine if the learning goal was met by the specific action plan/learning activity.  For example, the registrant may have attended a 2 hour course and claimed 2 credits for one learning goal.  Upon reflection, the registrant then decides that the course did not sufficiently address the identified goal; as such, they decide to pursue an additional learning activity to satisfy the goal – specifically, the registrant attends a 1 hour webinar and reads a newly published dental hygiene journal article on the same topic.  

The following example demonstrates how the registrant chose to apply the credits obtained toward the one learning goal.  Please keep in mind that this is only one example of how activity credits may be applied within the OLP: 

  • Within the OLP Guided Learning Plan: 
    • After reading the journal article and completing a reflection of learning the registrant applied 1 credits toward this learning goal.
    • Upon completion of the webinar the registrant applied 1 credit toward this learning goal.
  • Within the OLP Self Directed Learning Plan:
    • The registrant chose to apply the 2 credits for the in-person course toward their self-directed learning as it did not meet the identified learning goal in their guided learning plan.

It is important to note that several of the QAP Learning Activities have a maximum credit limit and therefore it would not be appropriate to claim for more credits than is permitted per QAP cycle. 

Documentation Webinar Questions:

How often does full periodontal charting need to be done (ie. probing, recession, mobility, furcations, etc)? 

CDHBC Practice Standard #3 indicates that dental hygienists must collect baseline assessment data as appropriate for the client and update the data as required, including periodontal examination data. 

The CDHBC does not make specific recommendations regarding the frequency of periodontal charting. However, it is considered to be an essential part of informing the dental hygiene diagnosis and treatment plan and should be regularly assessed. At periodontal maintenance appointments, updates for probing should be completed in a manner which aligns with the severity of the periodontal condition for the individual client. It is up to the dental hygienist’s professional judgment to determine if only an update is required or if the changes warrant full mouth probing. 

Some examples of how a periodontal charting documentation could be incorporated into practice at periodontal maintenance appointments after baseline periodontal assessment data is obtained and documented include, but are not limited to, the following:

  • Probing the full mouth and only writing down any changes in pocket depths as well as any pockets over 4mm. This information needs to be supported with a written notation in the clinical treatment notes stating that full moth probing was completed and all pockets greater than 4mm were recorded. 
  • Complete probing, but if there were no changes in probing depths, the registrant documents in the treatment record that full mouth probing was completed and that there were no changes from date X. 

Overall, it is important to ensure that there is legal documentation that the assessment was completed and subsequently documented appropriately. 

How should I document informed consent? 

CDHBC Practice Standard #1 states that a dental hygienist must obtain informed consent from the client or the client's representative before initiating dental hygiene care. 

Informed consent includes:

  • The client being made aware of benefits of treatment and how these treatments relate to the client’s oral/overall health 
  • The client being made aware of risks associated with care, along with risks of not receiving treatment 
  • The client being made aware of alternative treatments 
  • Client consent being given voluntarily

Informed consent is given by the client after the development and presentation of the dental hygiene diagnosis and treatment plan, which is based on assessment information. It is prudent for the dental hygienist to document in the client’s treatment record that informed consent was provided by the client prior to implementing the proposed care.  This may be accomplished in one of two ways:

  1. The client may sign in the treatment record indicating that they understand their oral condition and the proposed treatment plan 
  2. The dental hygienist may document in the treatment record that the client gave informed consent for treatment

Further information on informed consent may be found in the Fall 2013 Issue of Access.

Following obtaining informed consent at the initial appointment, does informed consent need to be documented at each recall?

At periodontal maintenance appointments, the requirement still applies for obtaining informed consent before providing dental hygiene care. There may be changes in the assessment data that could warrant changes to the dental hygiene treatment plan, which needs to be discussed with the client. In some instances, this may be a very brief discussion with the client if no changes have been noted and the client’s periodontal status remains stable. In other cases, a more thorough discussion may be necessary to discuss changes that have been observed during the assessments and any modifications that need to be made to the dental hygiene diagnosis and treatment plan. 

How often should you be taking blood pressure readings for clients?

Dental hygienists are responsible for providing safe and ethical care during all aspects of treatment. CDHBC Practice Standard #3 identifies the responsibility of a dental hygienist to assess the client’s needs, which includes the baseline readings and updates required based on the individual needs of the client.  
Registrants have a professional responsibility to base practice decisions on accepted “best practices”, which are supported by evidence and uphold the principles of safe and ethical care. It is incumbent upon registrants to remain current and to evolve their practice to align with the literature, as well as to incorporate the CDHBC Code of Ethics into their individual practice setting. This would include: 

  •  #1 - Hold paramount the health and welfare of those served professionally;
  •  #2 - Provide competent and appropriate care to clients;
  •  #9 - Maintain a high level of skill by participating in programs of continued study to update and advance their body of knowledge.

An accurate medical history and updating a client’s blood pressure prior to commencing dental hygiene care is important when it comes to identifying risks and potentially preventing complications associated with proposed care, such as the administration of local anesthetic. Measuring blood pressure also serves as a screening for clients who may be unaware of an underlying medical condition that may require a referral. 
The CDHBC encourages best practice for obtaining a baseline blood pressure for each client and then updating based on the needs of the client and on the interventions planned.  As such, a client’s blood pressure should be measured prior to the administration of local anaesthetic. 

How long are we legally required to keep client charts?

Independent dental hygienists who own clinics or mobile practices, own their client’s records. CDHBC Practice Standard #8.6 sets out the College’s record retention requirement for regulatory purposes. This requirement changed from a 10-year to a 16-year retention timeframe, effective April 1, 2014. Practice Standard #8.6 now states the following: “When the dental hygienist owns the client’s records, dental hygienists must retain records in a secure manner for no less than 16 years after the last client appointment.”
This change was made in order to align the CDHBC requirement with the new Limitation Act which came into force in June 2013.  Therefore, records for which the most recent entry was created on or after June 1, 2013 must be kept for 16 years from the date of last entry and records for which the most recent entry was created before June 1, 2013, must be kept for 31 years (the ultimate limitation period under the former Limitation Act, plus one year for service).

Retention of client records for a minor differs from that of an adult.  The client’s record must be kept until the minor turns 19 years of age, plus another 16 years.  Therefore, if the minor was last treated when they were 12 years old, the RDH would be required to retain the records for an additional 23 years (7 years until the age of 19 plus the required 16 years = 23 years). There are also special considerations that need to be given for persons with a disability. 

While a health practitioner’s regulatory college establishes how long client records must be kept in the event that they are needed for regulatory purposes such as complaint investigations or quality assurance proceedings, the Limitation Act establishes the time limits in place for a client to file a lawsuit in civil court. Aligning the CDHBC records retention requirement with the new Limitation Act helps to ensure that records are not prematurely disposed of when the regulatory requirement elapses, while other relevant legislation still prevails. 
The College recommends that independent dental hygienists obtain legal advice that is specific to their practice and circumstances, as needed.

Further information on records retention may be found in the Summer 2014 Issue of Access