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Promoting Oral Health Protocols in Long Term Care
- 3. Secure oral hygiene products for residents’ oral health kits. Develop a variety of oral health protocols. Promote the importance of daily oral care among staff for the residents in their care.
- 4. The oral health kit is based on the model used @ Deer Lodge Centre in Winnipeg.
- 5. April & May 2014 › In one Parkridge Centre neighborhood, Saskatoon Health Region – Oral Health Program dental health educators* (DHEs) provided: Initial oral health assessments using the Oral Health Assessment Tool (OHAT) Plaque index scores for baseline data to determine an improvement or decline in oral health Individualized daily oral care plans for each resident who had an OHAT Hands-on instruction/demonstration of how to provide daily oral care for various residents Referral and follow up of oral lesions or any untreated oral conditions Referral to U of S DDS students for exams, complete treatment plans, hygiene, restorative procedures, extractions and recall/follow up *one DHE involved is dually trained as a dental therapist and dental hygienist which brings an additional skill set to this program.
- 7. • This resource was distributed to residents and their families during the month of April 2014.
- 15. Next Steps › DHEs trained Clinical Nurse Educators (CNE) and one Speech Language Pathologist (SLP) on how to perform the OHAT and daily oral care. The Better Oral Health in Long Term Care training module was used. › Provided hands-on demonstration of daily oral care on the neighborhood with a variety of residents with varying dentitions and behaviors. › In the future, CNEs and neighborhood champions will train Continuing Care Aides (CCAs)on how to provide daily oral care.
- 16. CNEs are using life-like mannequins with oral cavities and teeth, to help staff become comfortable and competent in providing oral care.
- 20. October 2014 › Residents who were assessed in April/May received their 6 month OHAT follow-up by dental health educators and the neighborhood champions. › Plaque indices for comparison data were completed on all residents with natural teeth. › Any reported lesion for follow-up/observation was re-assessed for resolution and re-referred if resolution had not occurred.
- 21. October 2014 – continued › All individual oral care plans were updated and tooth brushes and perivex were replaced if required. › Any resident who did not have a daily oral care plan in their washroom was provided with one. › Any toothettes or mouthwash found in resident’s oral kits were removed. › Any resident requiring follow-up for an oral lesion was referred to CNE and Care Team Manager on the neighbourhood. › Chart audits were performed by DHEs. Several Parkridge Centre residents had been seen by the U of S DDS residents. Many had received exams and hygiene treatment and/or will receive complete treatment plans and restorative treatment and/or hygiene follow-up in the future.
- 23. Our 2 oral health champions were nominated for a Bravo Award for the work they have done at Parkridge Centre in regard to the LTC oral care pilot project!!
- 24. Jenni Smith & Lydia Spence
- 25. Continuous adjustments are being made to policy, processes, training and resources as required, until everything flows well. CNEs will continue adding new neighborhoods and training front-line staff, until daily oral care is fully implemented at Parkridge Centre. Each neighborhood will have two or more dedicated oral health champions depending on the number of residents residing in each neighborhood.
- 26. Thank you for your attention.
Notas del editor
- Parkridge dental clinic
- Rubber handled toothbrush – two tooth brush technique Proxabrush Perivex – not to be confused with Peridex Gel based moisturizer Antibacterial Not fluoridated Great for loosening dried secretions on the tongue and palate Great for individuals who cannot spit and swallow
- -Initially PI and GI were to be performed to have an overview of plaque and gingival health but with the limited cooperation of some or most residents the PI was the easiest index to use as no instruments (probe) were required -PI can only be scored on individuals with teeth, and scored visually, where as a GI requires the use of a probe
- Performing an OHAT Note PPE – gloves, masks, glasses – ALWAYS Work in pairs – one examiner, and one recorder (operator/resident safety, infection control and reduced examination time for resident)
- Modified to include -new section exterior of face -space under each section of the OHAT to make notes
- OHAT assessment can be performed anywhere Resident can be Sitting Standing In bed What ever time/location or scenario is most comfortable for resident
- -Selected residents with different behavioral issues and various dentitions Ie) CUD/CLD, edentulous, partial dentition
- Parkridge Dental Clinic
- -One resident deceased since original assessments -two residents would not cooperate from PI score, an improvement from the last visit where 4 residents would not cooperate, one resident refused on both occasions -Of the 17 residents with natural teeth: there was an improvement in 4 resident PI scores There was no change in 5 resident PI scores Unable to determine change/improvement in 4 resident PI scores There was a slight decline in one resident PI score There was significant decline in two resident’s hard tissues There was a significant reduction supre and sub cal of one resident Combined PI Score for the entire facility – 2.34 out of 3 **Ideally for a facility average, I would like to see this number reduced to 1.5-1.8
- -still seeing a disconnect with staff about the importance of daily oral care -many toothbrushes weren’t opened or used -any restorative treatment won’t hold up in the oral cavity if daily care is not being completed -champions, CNEs, care team managers and upper management must continue to promote daily oral care and stress the importance of mouth/overall body connection and maintaining residents dignity. -Paradigm shifts are slow, and we realize it will take time for all staff to buy in to the importance of providing daily oral care.
- -removal of all toothetttes from the facility, discontinuing ordering of all toothettes in general -improved availability of oral care supplies (rubber handled toothbrushes), standardized ordering of oral care products -dating perivex to track usage -drafting a dhyphagia policy -purchasing of Collis Curve toothbrushes? – proven to be very useful and helpful for residents with natural teeth on the dementia unit – to be purchased by the dental department? -ensuring when residents switch rooms their daily oral care plan follows them