Oral Care Matters: Improving Care through Applied Research, Assessment Tools and Best Practice Guidelines

Transcription

1 Oral Care Matters: Improving Care through Applied Research, Assessment Tools and Best Practice Guidelines Teresa M. Lee, BPSO Liaison Helen Niezgoda, Manager, Clinical Research Operations Maxim Parent, Research Coordinator CLRI Conference November 9, 2015 Ottawa, ON

2 Presenter Disclosure 2 Research Team: Helen Niezgoda, Tracy Luciani, Maxim Parent, Bev Shea, Bruyère Research Institute Carolle LePage, La Cité Collégiale Relationships with commercial interests: Grants/Research Support: N/A Speakers Bureau/Honoraria: N/A Consulting Fees: N/A Other: N/A This project is supported with funding from the Government of Ontario through the Bruyère CLRI. The views expressed in this publication are the views of the author(s)/presenter(s) and do not necessarily reflect those of the funder.

3 Disclosure of Commercial Support 3 This program has received financial support N/A This program has received in-kind support N/A Potential for Conflict of Interest: N/A.

4 Best Practice Spotlight Organization May 15, 2015 Saint-Louis Residence began our journey to become an RNAO Best Practice Spotlight Organization This is a three year process to implement four Best Practice Guidelines and develop strategies to sustain practice change into the future We have implemented the Prevention of Falls and Fall Injuries in the Older Adult BPG

5 A Best Practice Guideline (BPG) is... a comprehensive document providing resources for the support of evidence-based nursing practice. The document needs to be reviewed and applied, based on the specific needs of the organization or practice setting/environment, as well as the needs and wishes of the client. Guidelines should not be applied in a cookbook fashion but used as a tool to assist in decision making for individualized client care, as well as ensuring that appropriate structures and supports are in place to provide the best possible care RNAO

6 The Evidence Behind the Recommendations The development and review of a guideline is a rigorous process that includes but is not limited to: Nurses and health professionals with particular expertise in the practice area Review of the best available evidence Acknowledgment that evidence is evolving Regular revision

7 Oral Health BPG The second BPG being implemented is Nursing Assessment & Intervention An inter disciplinary implementation team is being established, which will include external partners such as Dental Hygienists and the Psycho-Geriatric ROH team Participation in Ontario Oral Health Community of Practice

8 21 May 2015 Gap Analysis Work Sheet RNAO BPG Recommendations (21) reviewed and an inter-disciplinary team determined if the recommendations were met/partially met/unmet in our home This analysis will determine the focus of our implementation strategy The inter disciplinary team will use this information to determine which recommendations will be implemented

9 Next Steps Engage existing Best Practice Champions Conduct a Knowledge Survey with staff Review existing educational strategies (CoP, CLRI) and develop educational plan based upon results of the Knowledge Survey Identify specific indicators to monitor over time effectiveness of the Oral Health Implementation Strategies and to promote revisions as required

10 As We Age medication usage hyposalivation (dry mouth) changes in pain perception not able to register pain dexterity not able to manually maneuver the tooth brush to reach back of the mouth cognitive impairment forgetting when and how to complete oral care

11 What We Know Oral care is not done well in LTC numbers of older adults are keeping their natural teeth LTC residents have less access to a hygienists /dentists Poor oral hygiene = risk factor for aspiration pneumonia Oral health = quality of life Dental Clinics Of North America [Dent Clin North Am] 2014 Oct; Vol. 58 (4), pp

12 What We Know Chronic Disease LTC Residents with no gum disease LTC Resident with gum disease Risk of Chronic Respiratory Disease < 2 5 X Risk of Coronary Artery Disease < 2 X Risk of Diabetes and Stroke < 2 4 X (Proceedings of the Periodontal-Systemic Connection: A State-of-the-Science Symposium Annals of Periodontology, 6(1), )

13 Providing Daily Oral Care in LTC Care staff key role PSW primary providers of oral care hygiene Task unpleasant, fear workload demands place oral hygiene at the bottom of the care list

14 Providing Daily Oral Care in LTC Training, resources cognitive impairment identifying changes in oral health when to report to registered staff RNAO BPG Oral health assessment tools in LTC reliable and valid?

15 Oral Health Assessment The Kayser-Jones Brief Oral Health Status Examination (BOHSE) comprehensive oral health assessment tool specifically designed for use by care givers on LTC residents tested on moderate-severe cognitively impaired residents takes time to administer BOHSE was modified to create the Oral Health Assessment Tool (OHAT) Has been tested in LTC

16

17 Goal of the Phase I Project Produce a French translation of the (OHAT) To determine if: French OHAT scores are the same as the English OHAT scores when both tools are applied to the same residents Quick and easy to use by registered staff

18 Goal of the Phase I Project Obtain and test oral photos that match OHAT categories To determine if: OHAT photos help Personal Support Workers (PSWs) identify change in oral health when compared to their OHAT assessment PSWs find OHAT photos useful and easy to use

19 Secondary Goal Determining the presence/absence and appropriateness of the residents oral care supplies

20 Design Sample Setting Project Plan Observational study over a 4 day period 47 participants Résidence Saint-Louis, Ottawa, Ontario Inclusion Criteria Consent was obtained resident or SDM Present on the unit during the data collection period Not in isolation or terminally ill

21 French Translation Initial translation (English into French) dental hygienist / translator Back translation (French to English) Comparison between OHAT Bruyère with Dalhousie French version Expert panel review (francophone - Dental Hygienists, Advance Practice Nurses and research staff )

22 PARTICIPANT Same Day Data Collection Plan RA + RN1 PART_1 RN1 PART_2 RN1 PART_3. RA + RN2 PART_1 RN2 PART_2 RN2 PART_3.. Informed consent Timed assessment Ensured evaluation completed Assessed available supplies Kept data collection on time and orderly RA + PSW RA + PART_1 DH PART_1 PSW PART_2 DH PART_2 PSW PART_3 DH. PART_3

23 Results Characteristics of the Sample Characteristic N % Gender Female 38 81% Physical Functioning (MDS-ADL Index Score) Score moderate to full assistance with ADLS 37 79% Cognitive Status (MDS CPS Score) Score 3-6 moderate to severe Cognitive Impairment 33 70%

24 Results Characteristics of the Tool Average length: 1min 32 secs Data collectors rated the tool as easy to use Difficult if resident was not as cooperative Difficult to fill out while wearing gloves Consensus: incorporate the photo flags into the OHAT tool

25 Results Gold standard comparison Comparing OHAT scores with the dental hygienist scores Categories that showed fair/moderate agreement English OHAT French OHAT Photo flag tool Tongue Tongue Tongue Dentures Gums and Tissues Gums and Tissues Oral Cleanliness Saliva Oral Cleanliness Oral Cleanliness Dental Pain

26 Results - Supplies 34 residents had natural teeth 28 residents had dentures Most residents had a regular toothbrush and regular toothpaste 26 had a denture container 22 had a denture cleanser 11 had a denture toothbrush 17 residents had mouth wash 4 residents had only 1 item**

27 Conclusion from Phase I More testing required on translation Some correlated well Tongue, Oral Cleanliness, Gums and Tissues *Chalmers: Saliva, oral cleanliness and dental were not comparing well Add photos to tool Staff recognized the importance of oral health and started to hand out supplies

28 Goal - Phase II Determine if certified dental hygienists will get the same scores when using both the English and French OHAT with photos on the same resident sample

29 Phase II Results Moderate/substantial agreement between French and English score for: Natural Teeth Oral Cleanliness Dental Pain Total Score Fair agreement for Gums and Tissues

30 Phase II Results Tool completion length English dental hygienist: 1min 22 secs French dental hygienist: 0 min 44 secs * *French dental hygienist was also used during Phase 1 - Familiar with the tool - Familiar with this population expect lower oral health?

31 Make them laugh Cues and Tricks Demonstrate what you are asking (open mouth, stick out tongue) Compliment their smile Gently touch the chin Turn the lights on or face a window Dolls/stuffed toys to make them at ease One liked to dance so the RN danced resident smiled and cooperated

32 Feedback from La Cité Students Liked the tool Helpful and easy to identify the oral health of residents Shocked to see the poor dental health of some residents Importance of a partnership between LTC staff and dental hygienist. Future LTC mobile dental clinic

33 Lesson Learned Research in LTC Study design Conducting oral care research in LTC challenging Why am I here Oral assessments difficult, training (cues, tools) Participant routine not on unit, ADLs Family involvement encouraged but limited Incidental finding reporting, cost Cognitive impairment informed consent Substitute Decision Maker accessing, time

34 Where do we go from here? French version has shown evidence of validity when compared with English Not all categories: Lips, Dentures Photos are a good feature work in progress If we can incorporate the tool into RNAO Best Practice Spotlight on Oral Care to do further testing on the tool

35 Build awareness Education Benefits Involve registered and unregistered staff in the research process Continue to build on the working collaboration between nursing staff and research staff at RSL Build collaborative networks Identify areas for future study (education, intervention)

36 Support Supported with funding from the Government of Ontario through the Bruyère Centre for Learning, Research and Innovation in Long Term Care. La Cité Collégiale Dental Hygiene Program, faculty and students Bruyère Research Institute (BRI) Dalhousie University Faculty of Dentistry Schlegel Research Institute for Aging