As we sought solutions for this critical issue, we needed to consider the following factors:
- In our skilled rehabilitation unit, the increase in short-term stays and managed care patients has meant more critically ill patients with advanced care needs. Some of these patients are admitted with tube feedings, oxygen, IVs or isolation needs.
- Patients who are NPO have an increased risk of aspiration pneumonia due to an increase in bacteria in the oral cavity. Therefore, the CNAs were often afraid to use a wet toothbrush on these ill patients.
- Research suggests that the patients most likely to get aspiration pneumonia are those who are dependent for oral care, dependent for feeding and missing multiple teeth.
Finding Solutions
There is a long-standing precedence of speech therapy addressing oral care as it relates to swallow safety and speech clarity. In the past, speech therapy recommended the use of a suction machine and suction toothbrushes for patients, but it was difficult to get follow-through as it was seen as a speech directive only.
As part of our sub-acute unit, our staff instituted the use of Sage Products suction toothbrush kits to help prevent VAP/HAP (ventilator/hospital-acquired pneumonia). An oral care decision tree was developed, nursing was trained and a system instituted to help nursing identify who the patients are, what the procedures are and who is responsible for the care. The decision tree is not the only solution, but it is beginning to work at Carmel Mountain Rehab.
Conclusions
In our facilities, the challenge of providing good oral care is not a new problem, but it is an important one. We do not often see the immediate results of poor oral care, but we do see the increase in infections, hospital transfers, poor patient outcomes and increased costs. A system to have nursing determine the patient’s needs gives them control and ownership over the process, which likely will lead to better compliance.
At Carmel Mountain Rehab, we are five stars because we continue to strive for better care for our patients, and we know that doing better than “good enough” has its benefits.