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

The Journey Begins

2010 – Meeting at the Willows, Saskatoon

2011 – Yearly treatments

Oral Health in Orientation to New Staff

Oral Health Education given to Existing

Staff

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

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.

C O M PA R E

“ L O N G I N T H E T O O T H ”

Receding

gums

Tartar

Thinning

enamel

Tooth

decay

NOV 2012

WHY

RE-INVENT

THE WHEEL?

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

Oral Health Assessment Tool (OHAT)

ORAL HEALTH CARE

PLAN(MIRROR CLINGS)

Dry erase

Reusable

At a glance

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

.

E1 TEAM = OUR CHAMPIONS

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.

Clinical Nurse Educators used a mannequin with teeth

and tongue to educate the staff and champions of each

NBHD

Tooth brushing

technique

in wheelchair

(video)

University of

Manitoba

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.

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.

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.

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

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

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.

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.

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

Practice on

each other

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.

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

SMILE !