Making oral hygiene a priority for aged and vulnerable patients

Have you ever thought about how important your mouth and teeth are to your health and everyday functioning? Consider that the mouth is the gateway to the rest of your body – not only for the good things like food and drink, but also for infection.

The importance of good oral health for maintaining general health is the focus of a Flinders Caring Futures Institute study aimed at implementing and sustaining multi-disciplinary strategies to reduce missed oral healthcare in hospital.

While toileting, showering and mobility are often front of mind when considering the fundamentals of care in the hospital environment, Co-Chief Investigator Dr Joanne Murray says it is not uncommon for older people to miss out on brushing their teeth as they normally would at home.

“Maintaining good oral hygiene through regular oral care is a simple low-cost infection control mitigation strategy that improves patient safety and quality of life. But we know that good oral healthcare is hard to deliver in hospitals.”

Missing out on proper oral hygiene can also lead to problems with eating and swallowing, resulting in malnutrition, infection and increased length of stay.

“Having an unclean, painful mouth that is not functioning properly and may be infected can also impact older patients’ feelings of self-worth and whether they feel valued in the hospital environment,” Dr Murray says.

In collaboration with Southern Adelaide Local Health Network (SALHN) and SA Dental and based at Noarlunga Hospital, The REDUCE (tRanslating knowlEDge for FUndamental CarE) project was launched to address this problem and explore the need to embed basic oral hygiene measures for aged and vulnerable patients in the health system. The team started at Whittaker Geriatric Evaluation Management (GEM) Unit located within the hospital.

Registered Nurse Debbie Courage and SP Zita Splawinski explain the implementation strategies at the launch of Whittaker Smiles, watched on by CEO of SA Dental, Mark Chilvers

Bringing together researchers in the Fundamentals of Care and Knowledge Translation teams from Flinders Caring Futures Institute, oral care experts from SA Dental Service including Co-Chief Investigator Dr Adrienne Lewis, and SALHN clinicians and managers, the project team investigated ways to ensure mouthcare and oral hygiene are properly considered when caring for every patient.

“We were able to raise awareness about best practice oral healthcare and improve availability of appropriate oral healthcare products, by engaging with frontline staff who are exposed to older patients on a day-to-day basis,” Dr Murray says.

The project team, supported by local facilitators, was also able to increase the knowledge and skills of staff, identify areas of improvement for assessing oral health through the electronic medical record system and contribute to the rollout of a SALHN-wide protocol for mouthcare.

“By systematizing best practice oral healthcare in SALHN, and keeping it front and centre on their Safety and Quality Committee, there are plans afoot to embed and sustain the changes made and to expand the program wider throughout rehabilitation and aged care,” Dr Murray says. “Plans to roll out across the Northern Adelaide Local Health Network’s rehabilitation and geriatric units are also under discussion.”

Excitingly, the blue-print for implementing, embedding and sustaining best practice oral healthcare developed through this program may be adopted by the National Safety and Quality Health Service (NSQHS) Standards in Comprehensive Care. Dr Murray has also been invited to share this blue-print with speech pathologists nationally through a Speech Pathology Australia professional development event.

Dr Murray says the support and enthusiasm shown by SALHN staff gives her confidence it is a sustainable, long-term plan to improve oral healthcare across the health system.

“We hope this project leads to greatly improved outcomes for our older and vulnerable patients in hospital settings well into the future.”

Dr Murray is joined by Flinders Caring Futures Institute researchers Dr Sarah Hunter and Dr Tiffany Conroy with the oversight of the Institute’s Foundation Director Professor Alison Kitson.

The project was made possible by a generous grant of nearly $20,000 from SA Dental Service.

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