Improving mouth care in an acute hospital trust

Maintaining good oral health is essential for long-term health. Poor oral health is linked to other health issues such as cardiovascular and gastrointestinal problems, while dental decay and pain affects wellbeing.

However, there are barriers to good oral health habits in hospital. For example, being admitted due to an emergency often means patients cannot bring a toothbrush and toothpaste with them, and it can take a few days before visitors can bring personal hygiene items with them.

Even patients who are admitted for elective surgery may need support from staff to brush their teeth. But staff themselves may not have time to support, or inexperienced staff may not be aware of the need to assist patients.

In this collaborative project between nursing academics and oral health professionals, we examined the issues around mouth care in hospitals and developed a set of recommendations to improve practice.

The project

We worked with staff in two acute orthopaedic wards to carry out scoping exercises, training, and evaluation.

An online survey was carried out to understand staff knowledge and practice in mouth care. 37 staff out of 70 responded to this initial survey, which revealed a number of results, including:

• 59% said they assessed patient’s oral hygiene daily, but 18% said “very rarely” and 15% were “not at all”.
• 59% responded that they assessed patients’ ability to perform mouth care daily.
• 46% thought that patients’ teeth needed to be brushed once a day, 44% said twice a day, and 10% said 3 to 4 times a day.
• All respondents were involved in denture cleaning. 24% said they cleaned dentures once a day, while 21% said cleaning was carried out after every meal.

Respondents generally noted a lack of time and staff, or lack of equipment as being barriers to providing mouth care. A minority were unaware of mouth care needs for patients.

The results of the survey were used to develop a training workshop with two oral hygienists from the University of Essex. Due to restrictions on staff time the workshop was designed to be delivered in just one hour and held at the ward education room at the hospital. It was run once a week for six weeks to give all staff opportunities to attend.

The workshop included guidance on how to carry out an oral health assessment, and practical demonstrations of good oral health care.

Results and feedback

Additional barriers were identified in the workshops and the feedback survey. Some staff felt that recording mouth care in patient notes was too time consuming, while Healthcare Assistants noted that they are not allowed to write in patient notes unless they were signed off by a nurse.

Others were concerned that creating a “mouth care tool” document or guidance would involve more paperwork. Concerns were also raised about the lack of on-site dentists, and how to provide mouth care to patients with dementia. A lack of senior staff engagement was noted, along with the difficulties for night shift staff to attend workshops held in the day.

As a result of this project we made several recommendations including:

• Mouth care training should be mandatory for staff, but provided in different formats.
• A mouth care assessment tool should be introduced to wards, along with “mouth care champions”.
• Doctors should be trained on how to diagnose and treat mouth conditions.