Authors (including presenting author) :
C Ip, FK Chow, SL Leung, MS Chan, KH Ting, T Yu
Affiliation :
Rehabilitation Department, Kowloon Hospital Rehabilitation Building
Introduction :
Among long-term elderly patients, those immobile with cognitive impairment are particularly at risk for untreated dental diseases, such as caries and periodontitis, and the resulted severe health consequences, such as aspirated pneumonia. Besides, elderly people today keep their natural teeth more and longer than before. It is a sign of better general health but it is also a potential high risk factor for oral and systemic infection if dental care cannot be well maintained as they become dependent. So, it is expected to have an increasing demand for dental care among our hospitalized dependent patients from now onwards. And, health care providers have increasing responsibility in quality tooth care provision to maintain their oral health. However, it is found that oral care is perceived as a low priority and was often delegated to assistants with a lower level of formal education. In some care setting, there is even a misconception that tooth-brushing is unsafe for immobile dysphagic patients. In addition, tooth-brushing procedure for dependent patients has not been described in the hospital nursing standard and the care manual for patient care assistants (PCAs). Due to the above reasons, and the other barriers, such as lack of time, staff, knowledge, confidence and etc, tooth-brushing for dependent dentate patients is often ignored by both health care providers and family caregivers.
Objectives :
This paper is to describe the promotion of tooth-brushing in a long-term care setting and its preliminary outcome in terms of oral cleanliness, sputum reduction & etc by clinical observation and family caregivers’ perception.
Methodology :
Subjects were all dependent tube-feeding patient in a long-term care ward. Before the program, educational talks on “mouth care and pneumonia”, “usage of mouth care product”, and “tooth-brushing techniques” were offered for all nurses and patient care assistants. Additional products, e.g. toothbrushes, open wide mouth rest and etc were purchased. A bedside coaching on oral care was given to eight senior nurses (future outcome evaluators). Moreover, a 9-item evaluation form is designed to compare the outcome before and after the program about the oral cleanliness (item 1 to 4), the amount of time and staff needed (item 5 to 6), and episodes of pneumonia, fever, and sputum (item 7 to 9) with clinical photo record of the oral cavity. Furthermore, a family caregiver satisfaction questionnaire was set to measure their satisfaction level periodically.
Result & Outcome :
From 23 November to 7 Jan 2019, among the 33 subjects of tube-feeding patients, 24 completed the evaluation for two of the 4 phases. The mean age of the 24 subjects was 59.9 (range: 34-93). Number of dentate patients was 23 (95.8%), with severe care resistant behaviours (CRBs): 7 (29.2%). The mean time for each oral care was 14.07 minutes and the mean number of helpers was 1.98. The mean increase of cleanliness score [0: no visible plaque, 3: plaque at all area] of teeth was: 0.24; palate: -0.08; tongue: 0.19; overall: 0.28 respectively. The mean satisfaction scores (0: no increase; 10: great increase) of family caregivers on oral care procedure, cleanliness and the perception score of sputum decrease (0: no decrease; 10: great decrease) are 5.8, 5.8 and 2.5 respectively (response rate: 54%). The results show mild increased cleanliness of teeth and tongue, and mild decrease at palate (-0.88 scores) by clinical observation and caregivers’ perception. It may be caused by CRBs that the mouth cannot be wide open at cleansing time. Hence, promoting mouth opening and tooth-brushing techniques has to be enhanced in the future phases. To achieve quality oral care among the long-term immobile patients, it is recommended to periodically update nursing standard, care manual on “tooth-brushing”; to enhance nurses’ monitoring role; to cooperate with dentists and initiate regular oral care education with bedside coaching for nurses and family caregivers in hospitals and RCHEs.
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