Transcript Dedicated Oral Hygiene Aide Program

DEDICATED ORAL HYGIENE AIDE
PROGRAM
BEDFORD VETERANS ADMINISTRATION HOSPITAL
BEDFORD MA
MOLLY DEHAAS BSN DDS
CHRISTINE LEWIS RDH
BEDFORD VA HOSPITAL
461 BEDS
LONG TERM CARE WARDS
SUBACUTE AND REHABILITATION WARD
ACUTE AND CHRONIC PSYCHIATRIC WARDS
ALZHEIMER’S WARD (GRECC)
MULTIPLE DRUG AND ALCOHOL REHABILIATATION PROGRAMS
WHAT DIDN’T WORK
EFFORTS TO EDUCATE STAFF ON THE IMPORTANCE OF
ORAL CARE
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PRESENTATIONS AT GERIATRIC GRAND ROUNDS
PRESENTATIONS AT NURSING GRAND ROUNDS
PRESENTATIONS AT THE NURSE MANAGER’S MEETING
REGULAR FEEDBACK TO NURSE MANAGERS ON THE QUALITY OF ORAL
CARE ON THEIR WARDS.
WHAT DIDN’T WORK
EFFORTS TO SUPPORT DIRECT CARE STAFF WITH SAFE
AND EFFECTIVE TECHNIQUES FOR ORAL CARE
 REGULAR PRESENTATIONS AT WARD STAFF MEETINGS
 BI-WEEKLY WARD VISITS BY HYGIENISTS TO AND PROVIDE
FEEDBACK AND SUPPORT STAFF WITH DIFFICULT PATIENTS
 PRESENTATIONS TO NEW STAFF MEMBERS
RESEARCH SHOWS THAT BETWEEN 0 AND 16% OF NURSING
HOME RESIDENTS ACTUALLY RECEIVE ORAL CARE EACH DAY
ORAL CARE PRVIDED BY CERTIFIED NURSING ASSISTANTS IN NURSING HOMES JAGS 54:138-143 2006
WHAT DIDN’T WORK
A PILOT PROGRAM WITH FOUR CERTIFIED
NURSING ASSISTANTS TO PERFORM ALL ORAL
CARE ON A LTC WARD
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THE GOAL WAS TO DECREASE THE MODIFIED GINGIVITIS INDEX BY 35%
WE WERE ABLE TO DECREASE THE GINGIVITIS INDEX BY ALMOST 50 %
THE CNAs WERE TRAINED AND SUPPORTED BY OUR HYGIENISTS
THE PROGRAM WAS VERY POPULAR WITH THE STAFF AND PATIENTS
WHEN THE PROGRAM WAS FINISHED THE STAFF RETURNED TO THE
PREVIOUS MODEL OF EACH CNA PROVIDING CARE FOR HIS/HER OWN
PATIENTS BECAUSE IT WAS LOGISTICALLY DIFFICULT TO MAINTAIN
WHY THE VARIOUS APPROACHES
DIDN’T WORK FOR US
• WHILE NURSING STAFF AND MANAGEMENT VALUED ORAL CARE, THEY
DID NOT MAKE EVALUATION OF THE QUALITY OF CARE DELIVERED A
PRIORITY
• SUPERVISORY STAFF WERE NOT COMFORTABLE WITH LOOKING IN THE
PATIENT’S MOUTH’S
• DIRECT CARE STAFF WERE NOT ACCOUNTABLE-ORAL NEGLECT WAS THE
RESULT OF NEGLIGENCE OF THE PART OF MULTIPLE CAREGIVERS.
• DIRECT CARE STAFF SOMETIMES LACKED SUPPLIES AND SKILLS
• PRESCRIPTION MEDICATIONS LIKE 1.1% NaF AND CHLORHEXIDINE DIDN’T
FIT INTO THE MEDICATION PASS ROUTINE SO FELL INTO A GRAY AREA
BETWEEN NURSING AND CNAs
DEDICATED ORAL HYGIENE AIDE
CONCEPT
• ONE AIDE HAS THE RESPONSIBILITY FOR DELIVERING ALL
ORAL CARE FOR A DESIGNATED NUMBER OF PATIENTS
• THIS AIDE DOES NOT HAVE OTHER RESPONSIBILITIES
• THIS IS CONTRARY TO CURRENT DIRECTION IN NURSING CARE
WHICH SEEKS TO MINIMIZE THE NUMBER OF DIFFERENT
CAREGIVERS
• ONE STUDY SHOWED THAT THE DEDICATED ORAL HGYIENE
AIDE CONCEPT DECREASED THE RISK OF PNEUMONIAS TO 1/3
OF THE CONTROL GROUP
Jags 56:1601-1607, 2006
KAISER GRANT
• WE WERE FUNDED FOR A 6 MONTH PROGRAM TO HIRE A
PERSON 6 HOURS A DAY TO DO ALL ORAL CARE ON AN
ALZHEIMER’S WARD
• WE SAW AN AMAZING IMPROVEMENT IN THE ORAL
CONDITION OF THE PATIENTS ON THIS WARD.
• THE PROGRAM WAS VERY POPULAR WITH WARD STAFF AND
THE PATIENT’S FAMILIES
• WE CHOSE A WARD WITH A NURSE MANAGER WHO ALREADY
HAD A STRONG CONCERN ABOUT THE QUALITY OF ORAL
CARE.
GETTING NURSING MANAGEMENT
BUY IN.
• THE NURSE MANAGER OF OUR PILOT WARD LOVED THE PROGRAM
AND ADVOCATED WITH THE DIRECTOR OF NURSING
• WE USED INTRAORAL PHOTOGRAPHS EXTENSIVELY: IT’S HARD TO
IGNORE GRAPHIC EVIDENCE THAT A PATIENT HAS HAD ORAL
NEGLECT FOR DAYS WITH THE TRADITIONAL SYSTEM
• WE WERE GIVEN ONE CNA WHO WAS BUDGETED BY NURSING
WHO WAS ON LIGHT DUTY TO CONTINUE THE PROGRAM ON BOTH
WARDS OF THE ALZHEIMER’ BUILDING
• OTHER NURSE MANAGERS BECAME AWARE OF THIS AND
ADVOCATED TO HAVE AN ORAL HYGIENE AIDE ON THEIR WARDS
• WE PRESENTLY HAVE THREE DEDICATED ORAL HYGIENE AIDES
WHO COVER 8 WARDS. THEY WERE SELECTED BECAUSE THEY
WERE SELF-MOTIVATED AND VALUED ORAL CARE
• THEY ARE SUPERVISED AND SCHEDULED BY NURSING AND
COME UNDER THE NURSING BUDGET
• THEY RECEIVE FEEDBACK FROM DENTAL STAFF MEMBERS
ABOUT QUALITY OF CARE, CONCERNS WITH SPECIFIC
PATIENTS
• THEY CAN SEE 30-40 PATIENTS/DAY
• THEY WORK VARYING SHIFTS (6A-2P OR 2 P TO 10 PM)
• THEY HAVE BEEN TRAINED BY OUR HYGIENIST
WITH DIDACTIC INFORMATION, CHAIRSIDE
TRAINING IN THE DENTAL CLINIC AND BY
SHADOWING MORE EXPERIENCED ORAL
HGYIENE AIDES
• THEY CARRY THEIR SUPPLIERS IN TOTE BAGS
SET UP TO AVOID CROSS CONTAMINATION
• THEY BRUSH TEETH AND CLEAN
INTERDENTALLY WITH FLOSS OR BRUSHES
• THEY CLEAN DENTURES AS NEEDED
• THEY APPLY 1.1% Na F GEL AND/OR
CHLORHEXIDINE WHICH IS ORDERED BY
ORAL HYGIENE BAG
BEDSIDE SET UP
PROS
• ALMOST ALL PATIENTS REALLY LOOK FORWARD TO
SEEING THE ORAL HYGIENE AIDES
• MANY PATIENTS WHO CHONICALLY REFUSED CARE
NOW ACCEPT CARE
• THE AIDES ARE FAMILIAR WITH THE PATIENTS
MOUTHS AND ARE QUICK TO REPORT CHANGES
AND CONCERNS TO DENTAL STAFF
• THE QUALITY OF OUR PATIENT’S ORAL CARE IS SO
MUCH BETTER.
CONS
• THE AIDES OCCASIONALLY GET DRAFTED TO PROVIDE FULL
PATIENT CARE WHEN STAFFING IS SHORT
• STAFF DEPENDS ON HAVING THE ORAL CARE DONE AND
WHEN THE AIDES ARE NOT PRESENT, ORAL CARE IS POOR,
EVEN WHEN STAFF IS NOTIFIED THAT THEY ARE RESPONSIBLE
FOR ORAL CARE THAT DAY.
• WE DON’T HAVE COVERAGE FOR ALL PATIENTS SEVEN DAYS A
WEEK AND ORAL CARE IS ONCE A DAY AT BEST
• PRESENTLY THE PROGRAM IS AT RISK BECAUSE IT HAS BEEN
CLASSIFIED AS A LOWER LEVEL IN THE VA SYSTEM THAN OUR
ORAL HYGIENE AIDES PRESENTLY ARE
THE FUTURE
• WE WOULD LIKE TO FIND A RESEARCHER
WHO COULD COMPARE THE NUMBER OF
TRANSFERS TO AN ACUTE HOSPITAL FOR
PNEUMONIA BEFORE AND AFTER
INSTITUTING THE ORAL HYGIENE AIDE
PROGRAM.
• WE WOULD LIKE TO GET 7 DAYS A WEEK
COVERAGE