The document outlines the history and goals of improving oral healthcare for long-term care residents in Saskatchewan. It discusses past projects providing dental care to residents and the formation of the Saskatchewan Oral Health Coalition to address this issue. The Coalition proposes an 11-goal strategy to establish standards and policies for regular assessments, treatment, education and coordination of oral healthcare for all long-term care residents in the province. The goals aim to ensure residents have access to ongoing oral care and its integration within overall healthcare.
At Health + Care Andrew Coles, Product Manager at Person Centred Software, and Jane Peterson, founder of Knowledge Oral Health Care, spoke about how good Oral Care improves Residents' Health and Wellbeing. They covered the importance of maintaining residents’ oral health for CQC compliance, and how care planning with Mobile Care Monitoring’s evidencing system supports management and evidence of oral health in care homes.
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DENTAL AUXILIARY
Dental auxiliary is a person who is given responsibility by a dentist so that he or she can help the dentist render dental care, but who is not himself or herself qualified with a dental degree.
The duties undertaken by dental auxiliaries range from simple tasks such as sorting instruments to relatively complex procedures which form part of the treatment of patients.
DENTAL SURGERY ASSISTANT
Non-operating auxiliary who assists the dentist or dental hygienist in treating patients, but is not legally permitted to treat the patient independently.
Also known as Dental assistant, Chair side dental assistant, Dental nurse
DUTIES
Reception of the patient
Preparation of the patient for any treatment
Provision of all necessary facilities such as mouthwashes and napkins.
Sterilization, care and preparation of instruments.
Preparation and mixing of restorative materials including both filling and impression materials.
DENTAL SECRETARY/ RECEPTIONIST
Assists the dentist with his secretarial work and patient reception duties
DENTAL LABORATORY TECHNICIAN
Non–operating auxiliary who fulfils the prescriptions provided by dentists regarding the extra oral construction and repair of oral appliances and bridge-work.
Also known as Dental Mechanics
DUTIES
Casting of models from impressions made by the dentist
Fabrication of dentures, splints, orthodontic appliances, inlays, crowns and special trays.
DENTURIST
Dental laboratory technicians who are permitted to fabricate dentures directly for patients without a dentists’ prescription.
ADA defines denturism as fitting and dispensing of dentures illegally to the public.
DENTAL HEALTH EDUCATOR
A person who instructs in the prevention of dental disease and who may also be permitted to apply preventive agents intra-orally.
SCHOOL DENTAL NURSE
Who is permitted to diagnose dental disease and to plan and carry out certain specified preventive and treatment measure, including some operating procedures in the treatment of dental caries and periodontal disease in defined groups of people, usually school children.
FUNCTIONS
Prophylaxis
Topical fluoride application
Administration of local anesthetic
DENTAL THERAPIST
Permitted to carry out the prescription of a supervising dentist, certain specified preventive and treatment measures including the preparation of cavities and restoration of teeth
DUTIES
Vital pulpotomy
DENTAL HYGIENIST
Is an operating auxiliary licensed and registered to practice dental hygiene under the laws of the appropriate state, province, territory or nation.
DUTIES
Fluoride and sealant application
screening
EXPANDED FUNCTION DENTAL AUXILIARY
Who has received further training in duties related to the direct treatment of patients, though still working under the direct supervision of a dentist.
Undertake reversible procedures which could be either corrected or redone without harm to the patients health.
DUTIES
Placing and removing rubber dams, matrix bands and temporary restorations
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Empowering ACOs: Leveraging Quality Management Tools for MIPS and BeyondHealth Catalyst
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Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
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Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
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1. Better Oral Care
in Long Term Care
Best Practice Standards in Saskatchewan
Saskatchewan Oral Health Coalition
October 27, 2014
Better Oral Care in Long Term
Care
3. History of Saskatchewan Oral Health
Projects in Long Term Care
o Dental Health Educators working within
their health regions have provided
assistance to LTC patients and/or staff.
o Individual dental therapists were providing
care in a few homes.
Better Oral Care in Long
Term Care
4. History of Saskatchewan Oral Health
Projects in Long Term Care
o In 2005 team discussions occurred.
o In 2007 the CDSS initiated the “Senior Oral
Services (S.O.S.)” project.
o 2008 – “Access to Care” seminar.
Better Oral Care in Long Term
Care
5. History of Saskatchewan Oral Health
Projects in Long Term Care
In 2006 the SDAA proposed a
“Dental Assistant Care Plan” for LTC”
Radiography (if available)
Fluoride
Oral hygiene instructions
Place Provisional Restorations
Desensitizing
Labeling dentures
Remove sutures, etc.
Better Oral Care in Long Term
Care
6. History of Saskatchewan Oral Health Projects
in Long Term Care
College of Dental Surgeons of
Saskatchewan
2007-2008
Regina: Saskatoon:
Santa Maria Senior Citizens Home St. Ann’s Senior Citizens Home
Full Dental Operatory Portage Dental Equipment
Dr. Maureen Lefebvre Dr. Raj Bhargava
Better Oral Care in Long Term Care
8. Initiatives such as
poster’s were sent
to each LTC home in
Saskatchewan
advocating oral care
Better Oral Care in Long Term
Care
9. History of Saskatchewan Oral Health
Projects in Long Term Care
Saskatchewan Dental Hygienists
Association
o Skill set
o Workplaces
o Oral Systemic Link
o Diabetes Link and Perio Brochure
Better Oral Care in Long
Term Care
10. Saskatoon Oral Health Coalition
o May, 2010 Coalition formed
o May, 2011 Oral Care in Long Term
Care was identified as a significant
goal
o (transcended to Saskatchewan Oral Health
Coalition – 2013)
Better Oral Care in Long Term Care
11. Steering Committee - SHR
In 2011, the Saskatoon Health Region and the U. of S
College of Dentistry partnered with Santa Maria and
St. Ann’s, (Community Wellness Grant) to provide:
o administration
o human resources (dental assistant)
o Operation of a pilot project for oral health care
Better Oral Care in Long Term
Care
12. Project Overview:
o provided education to long term care staff at two
long term care homes.
o Residents and their families were surveyed on basic
oral health information.
o The dental assistant works in two long term care
homes and facilitates treatment by:
Getting clients to the dental suite
Assists the dentist visiting the home
Works with staff to promote daily oral care
Better Oral Care in Long Term
Care
13. Saskatchewan Oral Health Professions
o January, 2012
o Saskatchewan made Long Term Care Strategy
o Our strategy would be based on the ‘best
practices’
o Present our strategy to the Saskatoon Oral Health
Coalition… health district personnel…
Saskatchewan Health
Better Oral Care in Long Term
Care
14. Saskatchewan Oral Health Professions
o College of Dental Surgeons of Saskatchewan
o Saskatchewan Dental Therapists Association
o Saskatchewan Dental Hygienists’ Association
o Saskatchewan Dental Assistants’ Association
o Dental Director, Saskatoon Health Region
Better Oral Care in Long Term Care
15. Collaboration:
o The committee developed a proposal for a LTC Strategy for
presentation to Saskatchewan Health;
o Reviewed “best practices” in LTC from around the world;
o Acquired access to the Australian model to be amended to reflect
our model for care;
o Secured funding from the SOHP Conference fund to contract
development;
o Hired a Masters in Public Health to develop the proposal
/presentation.
Better Oral Care in Long Term
Care
16. SOHP Overall Strategy:
o Resources made available to every health
region
o Resources made available to every long
term care home in Saskatchewan.
o Endorsed by government
Better Oral Care in Long Term
Care
17. SOHP Goal #1
That the Saskatchewan Government, Ministry of
Health endorse the Saskatchewan Seniors Oral
Health and Long Term Care Strategy developed by
the Saskatchewan Oral Health Professions
collaboratively with Long Term Care.
Better Oral Care in Long Term
Care
18. SOHP Goal #2
That legislated Oral Health Care Policies/Standards for Long Term
Care and Personal Care Homes are established based on best practice
to strive for optimal oral and overall health for the people of
Saskatchewan. Policies should ensure that every senior and long
term care resident has the right and access to oral health care
services:
2.1 An individualized oral health care plan
2.2 Basic oral hygiene supplies
2.3 Daily oral hygiene
2.3 Professional dental services
2.4 Oral health record included within the resident’s health record
2.5 Dental recommendations/orders are followed
Note: As per Section 23 of the current Personal Care Home Regulation, each resident
receive a dental examination, as necessary.
Better Oral Care in Long Term
Care
19. SOHP Goal #3
That an Oral Health Coordinator (OHC)(s), who is a licensed
oral health professional, should be employed in each health
region to facilitate the delivery of initial oral assessments,
dental examinations and treatment, daily oral hygiene for
residents and oral health education. The Oral Health
Coordinator will work collaboratively with the long term
care, multi-disciplinary team to improve the oral and overall
health of residents.
Better Oral Care in Long Term
Care
20. SOHP Goal #4
That upon entry into a Long-Term Care (LTC) home, an initial oral
assessment must be completed by a licensed oral health
professional, through the general/medical consent provided by the
long term care home.
4.1 Oral assessments should be routinely performed every 6
months thereafter, by an oral health professional or a
health care professional trained in oral health.
4.2 Non-oral health professionals performing oral health
assessments or care will receive appropriate training
developed by this project.
4.3 All training will be provided by oral health professionals.
Better Oral Care in Long Term
Care
21. SOHP Goal #5
That initial oral assessments may trigger a referral to a dentist for a full
dental examination to include:
5.1 Personal client record, including consent for dental examination
5.2 Review of medical and dental history
5.3 Complete examination of the oral cavity, to include:
5.3.1 Assessment of hard and soft tissues
5.3.2 Assessment of oral hygiene care
5.3.3 Oral cancer screening
5.3.4 Denture Assessment
5.4 Treatment plan/progress notes
5.5 Estimate/Consent for financial responsibility
5.6 Consent for treatment
Better Oral Care in Long Term
Care
22. SOHP Goal #6
Treatment needs based on the dental examination,
may be provided by dentists, denturists, dental
hygienists, dental therapists and/or dental
assistants. Residents may access dental services
through their personal oral health professional or
through dental services as available through the
long term care home.
Better Oral Care in Long Term
Care
23. SOHP Goal #7
That the Saskatchewan government
establish a safety net program for more
equitable access to oral health services
for low income residents.
Better Oral Care in Long Term
Care
24. SOHP Goal #8
That the Saskatchewan Seniors Oral Health
and Long Term Care Strategy is incorporated
into post-secondary educational health
training programs, orientation, and
continuing professional development (i.e. for
physicians, nurses, care aides, etc).
Better Oral Care in Long Term Care
25. SOHP Goal #9
That the standard for new long term care
homes includes provision for a treatment
room suitable for a variety of health
professionals including access to portable
dental equipment to facilitate dental
treatment.
Better Oral Care in Long Term
Care
26. SOHP Goal #10
That the implementation of a Saskatchewan
electronic health record includes an oral
health component.
Better Oral Care in Long Term
Care
27. SOHP Goal #11
That surveillance, evaluation and continuous
quality improvement be performed on an
ongoing basis to demonstrate improved
health and oral health status outcomes.
Better Oral Care in Long Term
Care
Hi – I am Susan Anholt. I am the Executive Director / Registrar of the Saskatchewan Dental Assistants Association. My role is to introduce you to the Better Oral Care Long Term Care Strategy along with an overview of the work that has brought us to this point. There was a time when a bad day at the nursing home occurred when all the dentures were collected for cleaning…
At that point, I seriously doubt that anybody was smiling! And that my friends is the true story of why we label dentures….
The earliest initiatives in for oral care in Long Term Care were provided by dental therapists working as Dental Health Educators. They have and continue to provide assistance to patients and staff. Even prior to this initiative there were individual dental therapists providing care in Parkridge Center and Sherbrooke Care Home in Saskatoon.
Noting that initial discussions began in 2005, clearly this has become a long term plan! My files indicated that the first team communications occurred in 2005, and at that point we all continued to work in our own silos! The College initiated the S.O.S. project in Regina in 2007 and by 2008, Dr. Uswak began presenting information on Access to Care.
As well, in 2006 the SDAA looked at the dental assistant competencies and started to talk to government & the oral health team about our scope of practice, and identified the day to day tasks that dental assistants could perform in a long term care environment. The identified skill list is there for your reading pleasure.
In 2007 and 2008 the College of Dental Surgeons of Saskatchewan conducted two pilot projects to provide dental assessments and treatment to Long Term Care (LTC) residents. These pilots were conducted in both Regina and Saskatoon. Both of these initiatives have produced the data required for the current initiatives.
This is the press release from the fall of 2008 that identified the College of Dental Surgeons initiative and the care that that the dental team were providing in St. Ann’s Home and Saskatoon Convalescent Home.
In 2011 SDAA sent this poster to every Long Term Care home in Saskatchewan. We got calls and letters asking, how could they deal with the treatment needs of their residents. Good question!
At the same time, The SDHA was identifying their skill set appropriate for long term care, and reviewing the enabling legislation to allow for their practice in this capacity. They also produced research data to raise awareness of the related health concerns.
Next, the Saskatoon Health Region called a meeting and everybody came! Yes, a Saskatoon coalition was formed and many oral care issues were identified. At a strategy session in May, 2011, oral care in long term care was identify as a significant issue. In October 2011… each association made a presentation on our individual initiatives in LTC. It was an eye-opener to say the least! We were all doing a different version of the same thing and it was past time to collaborate.
The Saskatoon Health Region and the College of Dentistry acquired a Community Wellness Grant. This project was able to produce significant oral health status data on residents in long term care. Thankfully, this project is still operational.
Specifically, through this project the Saskatoon Health Region provided education to long term care staff at two long term care homes and data was collected as residents and their families were surveyed on basic oral health information. Relative to the actual ‘care’ that clients receive; the dental assistant works in two long term care homes and facilitates treatment by: getting the clients to the dental suite, assists the dentist, and works with staff to promote daily oral care.
The Saskatchewan Oral Health Professions met in January, 2012 to collaborate on a strategy for oral care in long term care in Saskatchewan. There was unanimous agreement that this would be a collaborative team project. We determined that our strategy must include the Saskatoon Health Region as their initiatives relative to LTC were the most advanced in Saskatchewan. We agreed to develop a Saskatchewan made Long Term Care Strategy.
There was further agreement to review literature available and that our strategy would be based on the ‘best practices’ that have been developed globally.
The committee recognized that the majority of the current aging population have retained their teeth and many have sophisticated dentistry. Several committee members expressed the concern that this societal shift from dentures has created a need for oral health professionals and although nurses and care aides can meet the oral needs of most residents there will be residents with oral needs are beyond the capacity of care aides or exceed the time available to nursing staff.
We agreed our plan should consider geography and the availability of professionals. We agreed that awareness is the key to success and staff need to be trained to recognize a problem by “lifting the lip” and understand the connection between the mouth and general health.
The committee agreed to develop guiding principles for long term care and to develop guidelines relative to oral assessments and minimum standards of care.
Our initial step was to present our strategy to the Saskatoon Oral Health Coalition and seek feedback. We agreed that as our strategy was developed it would be presented to health district personnel and eventually Saskatchewan Health.
And yes, we are a team… Dentists, therapists, hygienists and assistants are all on-board, with the Saskatoon Health Region.
The committee developed a proposal for a LTC Strategy for presentation to Saskatchewan Health;
We reviewed a myriad of documents to identify the “best practices” in LTC from around the world;
We acquired access to the Australian model with permission to amend it to reflect our model for care;
We secured funding from the Saskatchewan Oral Health Profession Conference fund to contract the development of the manuals;
We hired a Masters in Public Health to develop the proposal /presentation.
What are our Goals? That our resources are endorsed by government and made available to every health region and every long term care home in Saskatchewan.
Goal 1: That the Saskatchewan Government, Ministry of Health endorse the Saskatchewan Seniors Oral Health and Long Term Care Strategy developed by the Saskatchewan Oral Health Professions collaboratively with Long Term Care.
Goal 2: That legislated Oral Health Care Policies/Standards for Long Term Care and Personal Care Homes are established based on best practice to strive for optimal oral and overall health for the people of Saskatchewan. Policies should ensure that every senior and long term care resident has the right and access to oral health care services:
2.1 An individualized oral health care plan
2.2 Basic oral hygiene supplies
2.3 Daily oral hygiene
2.3 Professional dental services
2.4 Oral health record included within the resident’s health record
2.5 Dental recommendations/orders are followed
And yes, the Personal Care Home Regulation requires that each resident receive a dental examination as necessary.
Goal 3: That an Oral Health Coordinator (OHC)(s), who is a licensed oral health professional, should be employed in each health region to facilitate the delivery of initial oral assessments, dental examinations and treatment, daily oral hygiene for residents and oral health education. The Oral Health Coordinator will work collaboratively with the long term care, multi-disciplinary team to improve the oral and overall health of residents.
Goal 4: That upon entry into a Long-Term Care (LTC) home, an initial oral assessment must be completed by a licensed oral health professional, through the general/medical consent provided by the long term care home.
4.1 Oral assessments should be routinely performed every 6 months thereafter, by an oral health professional or a health care professional trained in oral health.
4.2 Non-oral health professionals performing oral health assessments or care will receive appropriate training developed by this project.
4.3 All training will be provided by oral health professionals.
Goal 5: That initial oral assessments may trigger a referral to a dentist for a full dental examination to include:
5.1 Personal client record, including consent for dental examination
5.2 Review of medical and dental history
5.3 Complete examination of the oral cavity, to include:
5.3.1 Assessment of hard and soft tissues
5.3.2 Assessment of oral hygiene care
5.3.3 Oral cancer screening
5.3.4 Denture Assessment
5.4 Treatment plan/progress notes
5.5 Estimate/Consent for financial responsibility
5.6 Consent for treatment
Goal #6: This is a team event! Treatment needs based on the dental examination, may be provided by dentists, denturists, dental hygienists, dental therapists and/or dental assistants. Residents may access dental services through their personal oral health professional or through dental services as available through the long term care home.
Goal 7: That the Saskatchewan Government establish a safety net for low income residents, similar to Ministry of Health Supplementary Health/Family Health Benefits or Alberta’s Dental Assistance for Seniors Program through which low income seniors are eligible for up to $5000 every 5 years for those aged 65 and older.
Goal 8: That the Saskatchewan Seniors Oral Health and Long Term Care Strategy is incorporated into post-secondary educational health training programs, orientation, and continuing professional development (i.e. for physicians, nurses, care aides, etc).
Goal 9: That the standard for new long term care homes includes provision for a treatment room suitable for a variety of health professionals including access to portable dental equipment to facilitate dental treatment. So
Goal 10: That the implementation of a Saskatchewan electronic health record includes an oral health component.
Goal 11: That surveillance, evaluation and continuous quality improvement be performed on an ongoing basis to demonstrate improved health and oral health status outcomes.
I believe that together, we will make a difference!