Best practices for non dental professionals providing oral care in long term care facilities

BEST PRACTICES FOR NON-DENTAL

PROFESSIONALS PROVIDING ORAL

CARE IN LONG TERM CARE

FACILITIES

By

Vidya Shanmugam

CAREGIVERS PERCEPTION OF POOR ORAL

CARE IN LONG TERM CARE FACILITIES

1. Lack of knowledge of basic oral health and oral diseases

among care providers in the facilities.

2. Inadequate training at university level or at the LTC

facility about oral health and training on oral care

provision.

3. Time constraint faced by the staff, due to various other

works that has to be completed within a timeframe

4. Even if care staff were willing to provide oral care, the

most common barrier they faced were uncooperative

residents.

5. Lack of oral care supplies available to the care providers

for provision of daily oral care to the residents.

ORAL HEALTH EDUCATION PROGRAMS

Unsuccessful Programs

1. Lack of attendance of care staff for the training

program.

2. Lack of knowledge and training to provide adequate

oral care.

3. Time constraint faced by the care givers.

4. Lack of standard of oral care practice.

5. Lack of interest in oral care among both the

administrators and the care staff.

ORAL HEALTH EDUCATION PROGRAMS

Successful Programs (Conducted in Canada, Australia, United Kingdom and Norway)

1. A multidisciplinary approach should be made. This team should include care givers, oral health professionals, general physicians, facility managers and other key stakeholders.

2. An oral health coordinator (a dental hygienists/dental therapist) should be appointed, who aides in running the program.

3. An OCLN or “Oral Health Contact Person” (a qualified RN/LPN) can also be appointed. This person can aide in training other new caregivers and also help in checking if daily oral care is provided to the residents.

4. Caregivers should be pursued to follow guidelines and standard protocols when providing oral care.

5. Educational training should be provided to all caregivers. This training should be both theoretical and hands-on demonstrations.

6. Educational materials (information sheets, manuals) should also be provided along with training.

7. Funding should be made available for residents, who cannot afford to pay for their dental treatment.

BETTER ORAL HEALTH IN RESIDENTIAL

CARE (BOHRC) PROGRAM

“Gold Standard” program

Established to create an evidence based model which

can be utilized by general physicians, nurses and

other care workers in residential aged care.

The four key elements of the program were:

Oral health assessment, conducted by a general practitioner

and a registered nurse.

Oral care planning, to be developed by registered nurses.

Preventive oral care to be implemented by nursing staff and

other care workers.

Based on the oral assessment, dental referral should be done

for detailed oral examination and treatment.

EBPRAC - . Encouraging best Practice in Residential Aged Care program

ARCPOH - Australian Research Centre for Population Oral Health

BOHRC - Better Oral Health in Residential Care

BETTER ORAL HEALTH IN RESIDENTIAL

CARE (BOHRC) PROGRAM

Oral Health Education Toolkit

Professional portfolio

This portfolio was developed for General

Physicians and Registered Nurses as a self-

learning tool.

It contains,

Oral Health Assessment Toolkit

Oral Health Care Planning Guidelines

Dental Referral Protocol

BETTER ORAL HEALTH IN RESIDENTIAL CARE

(BOHRC) PROGRAM

Facilitator Portfolios

This portfolio was developed for the Registered Nurses, for them to provide educational training for the care workers.

It contains information on,

Principles in adult learning

Presentation tips

Competency outlines, session plans

Facilitator notes

DVD ( Dental Rescue)

CD with powerpoint presentation, pre and post quiz with downloadable answers

Resource kit

Posters

BETTER ORAL HEALTH IN RESIDENTIAL CARE

(BOHRC) PROGRAM

Staff Portfolios

It was developed for the direct care nurses and care

workers.

It comprises of three modules:

Module 1 – Good oral health is essential for healthy

ageing ( knowledge)

Module 2 – Protect your residents oral health (

skills)

Module 3 – It takes a team approach to maintain a

healthy mouth.

BRUSHING UP ON MOUTH CARE PROJECT

Developed in Nova Scotia in 2008

The purpose of this project was to examine the

effect of implementing oral care for frail and

dependent older adults in variety of continuing

care settings in Nova Scotia.

BRUSHING UP ON MOUTH CARE PROJECT

Educational Training Toolkit

Oral health manual

Oral care toolkit

Care Cards

Daily and annual oral health assessments

Posters

Information sheets on topics such as proper technique

for brushing and flossing

Oral care products and aids

Educational videos

BRUSHING UP ON MOUTH CARE PROJECT

Oral Care Toolkit

BRUSHING UP ON MOUTH CARE PROJECT

Oral Care Cards

ORAL HEALTH ASSESSMENT

Brief Oral Health Status Examination (BOHSE)

Oral Health Assessment Tool (OHAT)

RECOMMENDATIONS

What steps should be taken to ensure a

resident admitted in a LTC facility receives

good oral care?

This question can be answered if the following

subset of questions can be answered.

Who plays the key role in maintaining good oral

health of the residents?

What oral care measures have to be taken?

How will oral care be provided?

Where will oral treatment be provided?

RECOMMENDATIONS

Who plays the key role in maintaining good oral

health of the residents?

Policy makers

Long Term Care facility’s administrators/managers

Care staff

Oral health professionals

General physicians

Oral health coordinator

RECOMMENDATIONS

What oral care measures have to be taken?

Four key elements are important in providing oral

care to residents:

1. Oral Health Assessment

2. Oral Health Care Plan

3. Daily Oral Hygiene

4. Dental Treatment

Oral Health Assessment

Brief Oral Health Status Examination (BOHSE)

Oral Health Assessment Tool (OHAT)

Modified Oral Health Assessment Tool

RECOMMENDATIONS

Oral Health Care Plan

RECOMMENDATIONS

How will oral care be provided?

Care of Natural teeth

Care of Dentures

Prevention of gum disease

Relief of dry mouth

Reduce Tooth decay

RECOMMENDATIONS

Where will oral treatment be provided?

Dental services should be provided at the facility.

(or)

Transportation arrangements should be

available for the residents to travel to the dental

clinic.