Transcript Speech and Language Team and Nursing Staff

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
A reflective
stage follows
where changes
and
modifications
to the solution
can be made
The plan is put
into action and its
workings
observed and
monitored
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
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 Scale
• June 2009 - revise the oral care tool following
an audit of the tool and asking the nursing team
to make comment and changes of the tool.
• March 2009 – November 2009 to design a full
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 24,13141320.