Instructions for Using the Sample Screening Form

Adapting the Form
The form can be modified to reflect your specific clinical needs by adding criteria that reflect your practice or deleting criteria that are not appropriate for your practice. For example, if your patient population consists primarily of children, you may choose to add criteria that reflect the use of the device in small mouths.

Completing the Form
It is recommended that an appropriately trained staff person be designated as the safety coordinator for your clinic. In the screening phase, include a representative of each type of dental health care personnel (DHCP) that will be using or handling the device. Be sure that each person completing the form has a sample of the safer device as well as the traditional device in front them.

Interpreting the Results
Once the form has been completed by all DHCP, discuss the results to determine whether to proceed to the next phase – evaluating the safer device in the clinical setting. In making this decision, some criteria may be more important than others. For example, clinical and safety feature considerations may be more important than the general product (e.g., availability of the device) or practical considerations (e.g., instructions and packaging). If the responses to many criteria are “Does Not Meet Expectations” or “No,” then you should consider other safer devices, otherwise, evaluate the device in the clinical setting. 

Sample Screening Form
Dental Safety Syringes and Needles
 

This form collects the opinions and observations of dental health care personnel (DHCP) who screen a safer dental device to determine its acceptability for use in a clinical setting. This form can be adapted for use with multiple types of devices. Do not use the new device being tested on a patient during this initial screening phase.
 

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