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ParkRidge Centre Oral Health Journey

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May 11th 2015

Published in: Healthcare
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ParkRidge Centre Oral Health Journey

  1. 1. LTC SMILES: T H E J O U R N E Y O F I M P L E M E N T I N G A N O R A L H E A L T H P R O G R A M A T P A R K R I D G E C E N T R E
  2. 2. The Journey Begins 2010 – Meeting at the Willows, Saskatoon
  3. 3. 2011 – Yearly treatments
  4. 4. Oral Health in Orientation to New Staff Oral Health Education given to Existing Staff
  5. 5. Oral Health Concerns in LTC: Residents may have: • Decreased saliva due to medications (dry mouth) • Medications given with sweet sticky substances (Jam, jelled juice, applesauce , pudding ) • Few raw fruits and vegetables (self-cleansing) • Lack of proper daily mouth care • Cognitive issues that prevent entry into their mouths
  6. 6. How does poor oral health happen? Plaque (bacteria) builds up in the mouth on teeth, gums, cheeks and tongue. Approximately 40% of the tooth surface is “hidden” between the teeth, and can’t be reached by a toothbrush. Plaque is a thin sticky layer that can be brushed and flossed away. Plaque is full of hundreds of types of bacteria. When plaque hardens it becomes “tartar”. Tartar can form deep below the gum line. Tartar needs to be removed by professional dental cleaning at least once yearly. Brush at the gum line.
  7. 7. C O M PA R E
  8. 8. “ L O N G I N T H E TO O T H ” Receding gums Tartar Thinning enamel Tooth decay
  9. 9. NOV 2012 WHY RE-INVENT THE WHEEL?
  10. 10. The oral health kit is based on the model used @ Deer Lodge Centre in Winnipeg. Meetings with Material Management to bring products into our Stores inventory. EQUIPMENT
  11. 11. Oral Health Assessment Tool (OHAT)
  12. 12. ORAL HEALTH CARE PLAN (MIRROR CLINGS) Dry erase Reusable At a glance
  13. 13. INITIAL VISIT TO PARKRIDGE April & May 2014  In one Parkridge Centre neighborhood, Saskatoon Health Region – Oral Health Program dental health educators* (DHE’s) 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 .
  14. 14. E1 TEAM = OUR CHAMPIONS
  15. 15. JUNE 2014 Next Steps  DHEs trained Clinical Nurse Educators (CNE) and one Speech Language Pathologist (SLP) on how to perform the OHAT and daily oral care.  Provided hands-on demonstration of daily oral care on the neighborhood with a variety of residents with varying dentitions and behaviors.  CNEs and neighborhood champions then trained Continuing Care Aides (CCAs) on how to provide daily oral care.
  16. 16. Clinical Nurse Educators used a mannequin with teeth and tongue to educate the staff and champions of each NBHD
  17. 17. Tooth brushing technique in wheelchair (video) University of Manitoba
  18. 18. 6 MONTH FOLLOW-UP VISIT 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.
  19. 19. 6 MONTH FOLLOW-UP VISIT 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 on their mirror 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 NBHD.
  20. 20. ONGOING IMPROVEMENTS: Continuous adjustments are being made to policy, processes, training and resources as required, until everything flows well. CNEs continued adding new neighborhoods and training front-line staff, until daily oral care was fully implemented at Parkridge Centre. Each neighborhood has two or more dedicated oral health champions depending on the number of residents residing in each neighborhood.
  21. 21. WORK STANDARDS DEVELOPED (BY PRC STAFF DEVELOPMENT AND SHR DENTAL EDUCATORS) 1. Oral Care Routine Assessment: Basic assessment process 2. Proper Oral Health in LTC: Basic oral care for natural teeth Basic oral care for the Edentulous resident Oral care for a resident with dysphagia
  22. 22. PROPER ORAL HEALTH IN LTC: WORK STANDARD Special Considerations: Wheelchair oral care Lying down oral care Oral care to Uncooperative residents How to avoid being bitten Good communication Dry Mouth treatments Appropriate and Inappropriate Foam Swab usage Lip Lubricant guidelines Oral care for the unconscious resident
  23. 23. PRESENTLY AT PRC: Oral care has now been implemented on all NBHD’s, staff are practicing oral care techniques. Education is ongoing. Products have been assigned SKU numbers and can been ordered through our SHR Mat. Management (Stores) by the NBHD clerks.
  24. 24. PRESENTLY AT PRC: Staff are doing the care adequately, consistency is a problem. Re-assessments must be done, just in the process of implementing this plan. 4th year Nursing Students from U of S for doing follow-up education in Sept 2015 as part of their health promotion practicum.
  25. 25. LESSONS LEARNED: Patience: Changing practice is a slow process Have Managers and Nurses on Board: Have a nurse (RN, RPN LPN) within the NBHD team Old Habits Die Hard! Increased education and practice
  26. 26. Practice on each other
  27. 27. LESSONS LEARNED: Auditing/surveillance has to happen: Check in with staff one month after initial implementation / education. Check kits in rooms (for mouth care only) after one month.
  28. 28. LESSONS LEARNED: Check resident’s teeth, communicate to staff your findings. Takes a while to become a habit. Reminders: Emphasize foam “toothettes” not for cleaning Post bouquets and reminders Re-educate if needed Have the champions report any issues
  29. 29. SMILE !

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