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Nurse educators' initiative improves oral health of care home residents

Response was prompted by CQC report on lack of oral health training in many care homes
Picture shows an older woman holding a toothbrush in her mouth

Response was prompted by CQC report on lack of oral health training in many care homes

  • Training package devised by Devon nurse educators aims to improve oral health
  • Package provides care home staff with knowledge, tools, support and guidance
  • It includes information on cleaning dentures and oral care at the end of life
...

Response was prompted by CQC report on lack of oral health training in many care homes

  • Training package devised by Devon nurse educators aims to improve oral health 
  • Package provides care home staff with knowledge, tools, support and guidance
  • It includes information on cleaning dentures and oral care at the end of life
Picture shows an older woman holding a toothbrush in her mouth
Oral health is essential to overall well-being. Picture: Neil O'Connor

Responding to a Care Quality Commission (CQC) report which found that care home residents in England were not being supported to maintain and improve their oral health, nurse educators in Devon have devised a comprehensive training package for staff.

CQC and dental inspectors visited 100 care homes across the country over a four-month period to January 2019.

Their findings, published in summer 2019, showed that 47% of care homes were not providing staff training to support people’s daily oral healthcare and more than half had no policy to promote and protect oral health.

Of care homes visited, 70% said they included an oral health section in all, or mostly all, their care plans, but homes caring for people with dementia were less likely to have an oral health section in care plans, with 19% of staff saying they did not cover oral health at all.

Tips for oral health in care homes

  • Check if all residents are registered with a dental practice
  • Assess the mouth care needs of residents as soon as they are admitted to the care home, regardless of the length or purpose of their stay
  • If you are unable to obtain all necessary information needed for the assessment from the resident, with the resident’s permission, consider asking families or significant others
  • After the initial assessment, carry out oral health assessments at intervals of 6-12 months, or sooner if there is cause for concern
  • Consider using an oral health assessment tool to identify if residents need specific care and support
  • Regular toothbrushing is important to remove dental plaque and prevent or reduce the level of gum disease
  • Record mouth care provided and when people refuse mouth care
  • Remember oral health is essential to overall health and well-being
  • Oral health is important to enable individuals to eat and drink comfortably, to speak and smile and to be pain-free

Source: Northern Devon Healthcare NHS Trust oral health training package

 

Residential, nursing, supported living and domiciliary care homes have taken up the package

After the release of the CQC report, Rebecca Young, a nurse educator in the care homes team at Northern Devon Healthcare NHS Trust, streamlined a comprehensive training package she had been working on to provide care home staff with knowledge, tools, support and guidance on oral health.

Ms Young completed a Mouth Care Matters ‘train the trainer’ course run by Public Health England, then moved on to work on the local training package.

Since August 2019, a total of 42 services across residential, nursing, supported living and domiciliary care homes in north Devon have taken up offers of the package. More than 160 people including registered nurses, care staff and service managers have received the face-to-face, two-hour training, which is delivered by one of three nurse educators from the trust.

Picture shows nurse educator Rebecca Young
Nurse educator Rebecca Young

The package emphasises the importance of record-keeping for all elements of oral care and supports staff to signpost any issues to specialist services.

Ms Young says: ‘The role of the care homes team is to reduce avoidable hospital admissions through training and support, so oral health falls into our remit. 

‘The clients being cared for by domiciliary care agencies and residential care services have increased in terms of complexity. This complexity needs to go hand in hand with training to meet their needs.’

70%

of care homes include an oral health section in all or most of their care plans

Source: Care Quality Commission

Pharmacist provides support and guidance to the team on medication management

The care homes team educators are employed by the trust and comprise nurses and occupational therapists dedicated to educating and training the social care workforce in north Devon. A pharmacist provides support and guidance to the team on medication management in care homes.

The team can provide education on a wide range of topics, including prevention of urinary tract infections, sepsis, understanding dementia, pneumonia, flu and now oral health.

The oral health package includes information on cleaning dentures, oral care at the end of life, oral conditions, support for people living with a cognitive disorder or disability, and oral health CQC inspection criteria.

Poor dental care linked to strokes, complications in diabetes, heart disease and lung conditions

Ms Young says: ‘The feedback about the oral health training package has been extraordinarily positive from care and nursing staff.

‘We have an evaluation form that asks what specific knowledge or skills staff have gained that they will use in future practice.

‘We have had a whole range of answers, from staff saying they now know the appropriate way to clean dentures to recognising that dental services will visit clients who cannot physically get to the surgery.

‘Staff also said they now understand that poor dental care is linked to strokes, complications in diabetes, heart disease and lung conditions, not just tooth loss, decay and gum disease.’

Ms Young says those given training are also asked what they will do differently in future in terms of their clients’ oral health.

Review of face-to-face education and training during COVID-19

The care homes team at Northern Devon Healthcare NHS Trust was redeployed during the COVID-19 pandemic as face-to-face education and training was suspended.

The team’s nurse educators have been supporting rehabilitation and community teams, which has included visits to some of the homes they usually support with education and training.

More recently, the nurse educators have been able to offer face-to-face training where it has been felt appropriate, with social distancing in place.

Face-to-face education and training provision are set to be reviewed in autumn 2020.

 

How oral health training has changed practice

Responses to the oral health training package have included:

  • Incorporating oral assessments for all clients.
  • Using different methods to encourage those who do not want to brush their teeth, such as using different flavoured toothpaste and mirroring.
  • Making sure toothbrushes are changed every three months.
  • Encouraging clients to remove dentures at night due to choking risk.

Services receiving training encouraged to have an oral care link nurse

Ms Young has also been receiving positive responses from dental services about the team’s work.

‘I received an email from a dental nurse and mouth care champion in a maxillofacial department. She thanked us and said she treated a client who had benefited from the service and was impressed with the care prior to her visit.’

Ms Young says each service that receives the training package is encouraged to have an oral care link nurse, who receives additional training, support and networking opportunities to share good practice, how to overcome challenges and positive outcomes.

There are five link staff, but Ms Young anticipates that this will increase after the initial provision of the training to all services.

Audit will identify standard of oral care before and after training sessions

She says: ‘When we have sufficient oral care link staff we also aim to set up a link group to meet quarterly and discuss challenges and developments in oral care. The aim is to further enhance collaboration between ourselves and the services and among services.

‘We are also including an audit to identify the standard of oral care before and after training sessions, which will give us the opportunity to identify areas for development and improvement, to celebrate areas of excellence and enable us to monitor how well training is being embedded into practice.’

Petra Kendall-Raynor is a health journalist


Find out more

Care Quality Commission – Smiling Matters: Oral Health Care in Care Homes

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