Oral Care Programs: How to make it more than just swish ‘n spit

Do you have a robust oral care program in your facility? If not- your patients may well be suffering the consequences!

Take a moment and think about your morning routine – you get out of bed, hop into the bathroom, and probably brush your teeth as soon you are able to get the toothpaste out of the medicine cabinet. 

Also, think about the products you use.  Chances are you have a preferred brand of toothpaste, toothbrush, floss, and mouthwash.  Think about how your mouth feels first thing in the morning, and how satisfying it is to wash away that terrible overnight taste with some high-quality oral care products on your own choosing.  Now, consider being sick in the hospital and not having access to your preferred bands of oral care items or even having the physical ability to do your own teeth brushing. 

Imagine not being able to communicate to someone that you would like to brush your teeth, or need to wash a bad taste out of your mouth…

oral care program

As we know, effective oral care has a large host of benefits for our patients; most commonly, decreased occurrences of hospital acquired pneumonia.  Our patients are already battling enough while hospitalized – if we can prevent pneumonia then we need to!  But- getting that essential oral care completed can be a bigger challenge then we realize.  As clinicians we have a ‘check list’ of items we need to get accomplished when we work with our patients.  More often than not, oral care is completed during an activity of daily living (ADL) with occupational therapy (OT) or with nursing staff members.  It can also be completed in a speech therapy session with a speech-language pathologist (SLP).  Rarely, a physical therapist (PT) has been known to brush some teeth prior to gait training- but those occurrences are few and far between (we still love our PTs though!). 

So the questions must be asked… Who on the team is responsible for completing oral care with a patient?  Does it always have to be the nurse?  What items should you be using to complete oral care?  Can patients who are NPO or on thickened liquids still brush their teeth?  How do we as clinicians ensure that our patients are getting proper oral hygiene consistently?  Well the answer is… ORAL CARE PROGRAM! 

There is a laundry list of things that must be considered prior to formulating and implementing an oral care program.  These are some of my tips to get you started on your oral care program journey!  This information won’t give you exact step by step instructions on what oral care program or protocol to use but will instead give you things you need to consider while formulating your program.  You need to remember like much like everything else, oral care programs are not a ‘one size fits all’ item.  They need to be tailored to your specific work setting and patient population.  Get ready to use those clinical reasoning skills!

Check out these tips to get your oral care program off the ground!

1.  Assemble an interdisciplinary team.  As therapists, we like to think that our input is the most important and valuable, but that is not the case.  The best programs (regardless of focus) are ones that are molded by a team of nursing and therapy.  Therapy is not present 24/7 365… in all honesty it is the nursing staff of a given facility that spends the most time with the patient.  Nursing is mostly responsible for ADLs and the documentation that comes along with it.  By having a diverse group of individuals on your team you will get input from all points of view.  What works for therapy may not necessarily work for nursing and vice versa.  By having all departments represented your chances of having a successful program increase.

2.  Analyze your current process.  Take apart your current oral care process (if you have one) piece by piece and see what works and what does not.  This may be a good opportunity to interview staff and tease out what their barriers are.  Getting honest feedback will help you build a more realistic and successful program.  Also look at the current way oral care is documented in your medical record.  Is it cumbersome and hard to find?  Is it even being documented at all?  Looking at compliance for your current process will help you develop your new one and prevent you from implementing ineffective processes and interventions.

3.  Look at your oral care inventory.  Take stock of what items you have readily available to you for your oral care program and investigate if you are able to expand your inventory.  Basic toothbrush, toothpaste, and alcohol-free mouthwash are all an absolute must and there is a solid chance you have them stocked and ready to go.  Consider if you would like to add any other items to your stockpile. Suctioning toothbrushes (if you have wall suction available) are wonderful for patients who are NPO or on thickened liquids and then even come with their own packet of alcohol-free mouth rinse.  Tongue rakes are also a great addition to your oral care arsenal and are useful in the management of thrush.  Having things such as dental floss and lip balm are a nice way to round out your inventory of oral care products.  Not to be forgotten are our denture cleaning supplies – denture tabs and cups are items that should be readily available to you.  Knowing what you have and what you would like to acquire prior to formulating your program will help you maximize your budget and avoid an unnecessary ordering.  (Side note:  get a head lamp.  You’ll thank me later)

4.  Do your research!  This time one seems like a no brainer, but it is important to highlight taking ample time to research what evidenced based protocols are out there and what could possibly be a good fit for your facility.  Many items are floating around in cyber space but do your due diligence and see which ones are the most up to date.  Using a formalized assessment tool such as the Oral Health Assessment Tool (OHAT) may be a good driving force for your program as it is objective, measurable, and easy/timely to administer.  The OHAT also makes clinical recommendations based on the patient’s score which make formulating a program a little less painful.  Check out this link, for more information on the OHAT!

5.  Consider how you want to educate your staff.  This is incredibly important as the people completing the new oral care protocol with the patients will need to know when, how, and why.  Taking the time to orchestrate a thorough, formal staff education program will help with a smoother rollout and compliance from staff members.  Perfection right from the start should not be expected.  Instead, be proactive and schedule follow up education sessions and in-services to ensure staff carryover and compliance.  Be sure to periodically audit you program and see if and where any breakdowns are occurring so you can address them.  If those items continue to be a pain point for your program you need to be willing to tweak your program to make it more effective.

Establishing any new program at a healthcare facility can be a daunting and overwhelming process.  Always remember to take a step back and remember why you are doing what you are doing – for the betterment of your patients.  Check in and think about how you would feel if you were unable to brush your teeth when and how you wanted.  It will make developing this program more seamless and meaningful.  BRUSH THOSE TEETH.  No one wants pneumonia. 

Interested in learning more about the ethical and social barriers related to dysphagia? You will love our 3- cont. ed hour seminar, Life with Dysphagia: Knocking down Social & Ethical Barriers! This course will teach you fantastic tools to focus on the unseen consequences of dysphagia, and provide you with the tools to empower your patients and caregivers with swallowing issues.

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