Speech and Language Therapist and Nursing Staff

Joint Initiative - Oral Hygiene

Our story so far

Oral Hygiene

Joint Initiative

• Main hypothesis is to show how an oral care

assessment tool, alongside an educational

package can improve oral care of patients

Why is Oral Hygiene Important?

• Patient comfort

• Psychological wellbeing

• Prevention of migration of oral / dental bacteria which can lead to aspiration pneumonia

Why Nursing Staff ?

• Oral Hygiene is an important element of nursing care.

• We wish to improve the care we give our patients.

Why Nursing Staff?

• Nursing Staff should be aware of how

uncomfortable it can be for our patients who

experience dry and sore mouths due to their

illness and the use of certain medications..

Why Speech Therapists?

• SLTs are frequently involved in oral care as part of

treatment of speech and swallow disorders

• Spend lots of time observing and manipulating structures

within the oral cavity

• Both speech and swallow are hindered by dry, cracked,

coated, uncomfortable lips and tongue

Oral Hygiene Assessment

• There is much variability in methods and therefore

effectiveness of oral assessment and oral care

given

• Variations in: frequency process equipment products

Oral Hygiene Assessment

• Consensus in the literature that an evidence

based, standardised assessment should be the

basis on which a care plan is devised, tailored to

each individual and prevent secondary clinical

complications

Oral Hygiene Assessment

• Oral care is often not specific to the individual or

clinical presentation and so may not improve

oral health

Oral Hygiene Assessment

• There is no universally agreed tool to assess

oral hygiene

• Standardised assessment should be carried out

at regular intervals to monitor and adapt the care

plan as clinical improvement or deterioration

occurs

Our Oral Assessment

• Based on the Revised Oral Assessment Guide

(ROAG) by Andersson et al (2002) which is

modified from Eilers at al (1988)

• ROAG demonstrated inter-rater reliability, was

clinically effective and represented a standardised

approach to oral assessment

Our Oral Assessment

• The ROAG comprises 8 parameters and for each

parameter a method of assessment is outlined.

• The instructions were elaborated upon for some

parameters to make them easier to assess and

score

Our Oral Assessment

• Parameters:

voice lips

mucous membranes tongue

gums teeth / dentures

saliva swallow• Each scored out of 3:

1 – normal 2 – moderate problems

3 – severe problems

Our Oral Assessment

• Further risk factors for poor oral hygiene from the

literature have been included:

steroid treatment diabetes

oxygen therapy mouth breathing

radio / chemotherapy modified fluids

NBM smoking

• Who is administering oral hygiene has also been added.

Our Oral Assessment

• The completed assessment is scored out of 40

• Score indicates a treatment plan, including frequency of oral care needed, fluids and products to use

Research Design

• The research design used is based on the

stages of the action research process identified

by McGarvey 1993

Action Research

The problem to be studied is identified

Problem concepts are investigated and related literature is studied The plan of action to solve the problem is designed

The plan is put

into action and its

workings

observed and

monitored

A reflective stage follows where changes and modifications to the solution can be made

Methodology

• To create an oral assessment tool which is

supported by an educational package

• To audit the effectiveness of the tool by piloting it

first on the Macmillan unit, then to invite other units

such as MFE and Critical Care areas to pilot the

tool, (educational sessions).

Methodology

• To design a treatment plan and a decision tool to guide the use of oral care products.

• To disseminate to the Hospital Trust by changing the nursing policy and planning targeted educational sessions.

Methodology

• To design an educational approach throughout –

Face to Face teaching followed by Pictorial/DVD

guide “How to Guide”, easy reference and e –

learning package which is accessible to all

areas, (this will be audited after 12 mths

following the roll out of first teaching sessions.)

Time Scale

• February 2009 – Teaching sessions to show the

Nursing staff how to assess a patient’s mouth,

the importance of oral care/health and how to

use the tool and oral care products.

• March 2009 – Roll out of the oral care

assessment tool pilot

Time ScaleTime Scale

• June 2009 - revise the oral care tool following - revise the oral care tool following

an audit of the tool and asking the nursing team an audit of the tool and asking the nursing team

to make comment and changes of the tool.to make comment and changes of the tool.

• March 2009 – November 2009 to design a full to design a full

educational package to support the tool.educational package to support the tool.

Time Scale

• September 2009 – January to liaise with the

Policy and Standards Group to introduce the

proposal to change the nursing policy.

• September 2009 – January 2010 to

target/invite other units such as MFE and Critical

Care to begin to pilot the tool in their areas

Time Scale

• January – March 2010 to roll out educational sessions and support to areas.

• March 2010 to begin the pilot of the Oral Assessment Tool.

References

•McGavery, H. 1993. Participation in the research process: action research in nursing. Professional Nurse. March p 372-376

•Andersson P, Hallberg IR, Renvert S: Inter-rater Reliability of an Oral Assessment Guide for Elderly Patients Residing in a Rehabilitation Ward. Spec Care Dentist 22: 5, 181-186, 2002

•Rolfe G (1994) Towards a new model of nursing research. Jnr of Advanced Nursing 19, 969-975

•Rolfe, G. 1996 Going To Extremes: Action Research Grounded Practice and The Theory-Practice Gap In Nursing. Journal Of Advanced Nursing 24,1314-1320.