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  1. Oral Care: Part 3a Assessment Using a Best Practice Approach in Long-Term Care February 2008 Central South/South West Best Practice Coordinator in Long-Term Care Initiative

  2. Introduction: Learning Objectives Learn about A best practices approach to oral hygiene assessment Using a standardized oral hygiene assessment tool for nurses in LTC RAI-MDS : Dental Care RAP February 2008 Central South/South West Best Practice Coordinator in Long-Term Care Initiative

  3. Evidence-Based Approach to Oral Care for Older Adults from IOWA • This evidence-based model of the importance of oral hygiene care and dental treatment on maintaining oral health from IOWA highlights several key areas: • Regular daily oral care • Preventive oral care • Assessment • Secondary & tertiary dental care •  • Impacts • Systemic health • Nutrition • Quality of life • Overall well-being February 2008 Central South/South West Best Practice Coordinator in Long-Term Care Initiative

  4. A Best Practices Approach to Oral Care in LTC homes Assessment • Review your own personal oral hygiene beliefs • Identify factors that increase the risk for oral problems • Refer to Part 1: Introduction slides • Complete a baseline oral health assessment • Oral hygiene beliefs • Use standardized assessment tools • Requirements for RAI-MDS • Complete an assessment of current oral care February 2008 Central South/South West Best Practice Coordinator in Long-Term Care Initiative

  5. RNAO Oral Health BPGAssessment February 2008 Central South/South West Best Practice Coordinator in Long-Term Care Initiative

  6. RNAO Oral Health BPGAssessment February 2008 Central South/South West Best Practice Coordinator in Long-Term Care Initiative

  7. A Best Practices Approach to Oral Care in LTC homes Assessment • Review your own personal oral hygiene beliefs • Beliefs about oral hygiene • Age, culture, appearance • Health • Dental care • Beliefs about oral care • Frequency, products, practices • Providing oral care to others • Any other beliefs/factors that may impact LTC? February 2008 Central South/South West Best Practice Coordinator in Long-Term Care Initiative

  8. A Best Practices Approach to Oral Care in LTC homes Assessment • Identify factors that increase the risk for oral problems • Refer to Part 1: Introduction slides February 2008 Central South/South West Best Practice Coordinator in Long-Term Care Initiative

  9. Individuals at Risk for Oral Diseases • Cognitively impaired  History of tooth decay • Neurological conditions  Swallowing problems • Dry mouth / under active salivary glands  Diabetes • Behavioural problems during oral hygiene • Immunocompromised • Individuals who experience any of these problems are at increased risk for plaque-related oral diseases • . . . . . related to their inability to perform adequate self-care and their medical, mental, physical and/or psychosocial conditions • REMEMBER: cultural and personal beliefs about oral care may increase risk for oral diseases February 2008 Central South/South West Best Practice Coordinator in Long-Term Care Initiative

  10. Individuals at Risk for Oral Diseases • Cognitively impaired elderly are at HIGH RISK for dental diseases because they • Often forget • May be unable to continue oral hygiene • May resist assistance • Have difficulty perceiving and reporting pain or discomfort February 2008 Central South/South West Best Practice Coordinator in Long-Term Care Initiative

  11. A Best Practices Approach to Oral Care in LTC homes • Complete a baseline oral health assessment Oral hygiene beliefs • Screening tool: • Refer to the Appendices in RNAO’s Oral Health BPG for Hygiene Beliefs and Personal Practices sample questions that can be used during assessment February 2008 Central South/South West Best Practice Coordinator in Long-Term Care Initiative

  12. A Best Practices Approach to Oral Care in LTC homes • Complete a • baseline • oral health • assessment • Standardized • Assessment • Tool • Use a valid and • reliable tool that • measures oral • health status of • LTC residents • OHAT for Nurses in LTC February 2008 Central South/South West Best Practice Coordinator in Long-Term Care Initiative

  13. A Best Practices Approach to Oral Care in LTC homes • Oral Health • Assessment • Tool for Nurses • (OHAT) • A Standardized • Assessment • Tool that measures oral health status of LTC resident • To learn how to use the OHAT, refer to • Part 3b: Assessment – OHAT • Introducing the Oral Health Assessment Tool slides • Halton Region Health Department February 2008 Central South/South West Best Practice Coordinator in Long-Term Care Initiative

  14. A Best Practices Approach to Oral Care in LTC homes • Complete a • baseline • oral health • assessment • RAI-MDS • Requirements February 2008 Central South/South West Best Practice Coordinator in Long-Term Care Initiative

  15. A Best Practices Approach to Oral Care in LTC homes • Oral • Health • Assessment • RAI-MDS • Requirements February 2008 Central South/South West Best Practice Coordinator in Long-Term Care Initiative

  16. A Best Practices Approach to Oral Care in LTC homes • Oral Health Assessment • RAI-MDS Requirements: What triggers a Dental Care RAP? • Dental Care or Oral Health problem suggested if: • L1a Mouth Debris (dental care) • L1c Some/all natural teeth lost and does not have or does not use • dentures (oral health) • L1d  Broken, loose or carious teeth (oral health) • L1e Inflamed gums, oral abscesses, swollen/bleeding gums/ulcers, • rashes(oral health) • L1f  Less than daily cleaning of teeth/dentures (dental care) • K1c Mouth pain (oral health) • No Quality Indicators at this time February 2008 Central South/South West Best Practice Coordinator in Long-Term Care Initiative

  17. A Best Practices Approach to Oral Care in LTC homes • RAI-MDS Requirements: What triggers a Dental Care RAP? • Dental Care or Oral Health problem suggested if: • L1a Mouth Debris (dental care) • L1c Some/all natural teeth lost and does not have or does not use dentures (oral health) • L1d  Broken, loose or carious teeth (oral health) • L1e Inflamed gums, oral abscesses, swollen/bleeding gums/ulcers, rashes(oral health) • L1f  Less than daily cleaning of teeth/dentures (dental care) • K1c Mouth pain (oral health) • Oral Health Assessment • OHAT Standardized Tool = February 2008 Central South/South West Best Practice Coordinator in Long-Term Care Initiative

  18. A Best Practices Approach to Oral Care in LTC homes:Oral Health Assessment • RAI-MDS & Dental Care RAP and OHAT Standardized Tool • The OHAT has never been validated against MDS 2.O RAI sections K and L • Oral Health/Dental Care (eg., unlike RAI-MDS and Folstein >> CPI Outcome Scale) • Research has shown that • people did not use the MDS oral/dental sections well • there was poor identification of oral health problems on RAI-MDS (e.g., mouth pain) • there was no correlation between what was recorded on RAI-MDS and any subsequent • oral care actions or interventions • when proper oral assessments were completed before completion of the RAI-MDS – this • information led to increased accuracy on RAI-MDS • What does this mean to LTC homes using RAI-MDS? • Best Practices Approach to Oral Care in LTC Homes using RAI-MDS • means • Nurses should use a standardized tool such as the OHAT to complete an oral health assessment before and in addition to completing RAI-MDS oral /dental sections February 2008 Central South/South West Best Practice Coordinator in Long-Term Care Initiative

  19. Resources • Canadian: • The Registered Nurses Association of Ontario (2008) . Oral health. Nursing assessment and interventions. Toronto, ON: Author. www.rnao.org(Recommendations Fall 2007). • The Registered Nurses Association of Ontario and Halton Region Health Department (Summer 2007). Oral care for resident with dementia (DVD)Toronto, ON: Author. www.rnao.org or phone Dir: (416) 907-7965 Fax:(416) 907-7962 $15 CDN • ML van der Horst (April 2007). The BP Blogger. Myth busting: The mouth issue. Monthly newsletter for LTC that dispels care myths with evidence from best practice guidelines. Available at: www.rgpc.ca • Halton Region Health Department (2006). Dental health manual for LTC home staff. Halton oral health outreach project. Oakville, ON: Author. • Centre for Community Oral Health- Long Term Care Fact Sheets. Nov 2006 www.umanitoba.ca/faculties/dentistry/ccoh • Best Practice Coordinators in Long-Term Care Initiative – Central South/South West (February 2008). Best Practices Approach to Oral Care Resource Kit.www.rgpc.ca • Oral Care.ca www.oralcare.ca February 2008 Central South/South West Best Practice Coordinator in Long-Term Care Initiative

  20. Resources • Others: • The University of Iowa College of Nursing (2002). Oral hygiene care for functionally dependent and cognitively impaired older adults. Evidence-based practice guideline. Iowa City, Iowa: Author/Gerontological Nursing Interventions Research Center. www.nursing.uiowa.edu • Joanna Briggs Institute (2004). Oral hygiene care for adults with dementia in residential aged care facilities. Best Practice, 8(4). Adelaide, Australia: Author. www.joannabriggs.edu.au February 2008 Central South/South West Best Practice Coordinator in Long-Term Care Initiative

  21. References Canadian Institute for Health Information (March 2005). Resident Assessment Instrument (RAI) MDS 2.0 and RAPs Canadian Version. User’s Manual (2nd ed.). Ottawa, ON: Author. Fallon, T., Buikstra, E., Cameron, M., Hegney, D., Mackenzie, D., March, J., Moloney, C., & Pitt, J. (2006). Implementation of oral health recommendation into two residential aged care facilities in a regional Australian city. International Journal of Evidence-Based Healthcare, 4, 162-119. Federal, Provincial and Territorial Dental Directors. (2005). A Canadian oral health strategy. Accessed January 4, 2007. Available at: http://www.fptdd.ca/Canadian%20Oral%20Health%20Strategy%20-%20Final.pdf. Frenkel, HF., Harvey, I., & Needs, KM. (2002). Oral health care education and its effect on caregivers’ knowledge and attitudes: a randomised controlled trial. Community Dentistry and oral Epidemiology, 30, 91-100. Frenkel, H., Harvey, I., & Newcombe, RG. (2001). Improving oral health in institutionalised elderly people by educating caregivers: a randomised controlled trial, 29, 289-297. Nicol, R., Sweney, MP., McHugh, S., & Bagg, J. (2005). Effectiveness of health care worker training on the oral health of elderly residents of nursing homes. Community Dentistry and Oral Epidemiology, 33, 115-124. Pearson, A. & Chalmers, J. (2004). Oral hygiene care for adults with dementia in residential aged care facilities. Systematic review. JBI Reports, 2, 65-113. February 2008 Central South/South West Best Practice Coordinator in Long-Term Care Initiative

  22. References Seniors Oral Health Collaboration for the Nova Scotia Department of Health (SOHC). (2006). The oral health of seniors in Nova Scotia. Policy Scan and Analysis: Synthesis report. Accessed January 15, 2007. Available at: http://www.ahprc.dal.ca/oralhealth/Reports/FINAL.pdf Thorne SE, Kazanjian A, & MacEntee. (2001). Oral health in long term care: The implications of organisational culture. Journal of Aging Studies, 15, 271-283. US Department of Health and Human Services (US DHHS) (2000). Oral Health in America: A Report of the Surgeon General. Rockville, MD: National Institute of Dental and Craniofacial Research, National Institutes of Health. Accessed January 15, 2007. Available at: http:/www.nidr/nih.gov/sgr/oralhealth.asp Wardh, I., Hallberg, L., Berggren, U., & Sorensen, S. (2003). Oral health education for nursing personnel: experiences among specially trained oral care aides: One-year follow-up interviews with oral care aides at a nursing facility. Scandinavian Journal of Caring Science, 17, 250-256. WHO. (2003). The world oral health report. Continuous improvement of oral health in the 21st century – the approach of the WHO Global Oral Health Programme. Geneva, SW: author. Accessed: January 15, 2007. Available at: http://www.who.int/oral_health/publications/report03/en/ February 2008 Central South/South West Best Practice Coordinator in Long-Term Care Initiative

  23. For more information: Mary-Lou van der Horst, RN, BScN, MScN, MBA Regional Best Practice Coordinator Long-Term Care Central South Region-Ministry of Health and Long-Term Care  Village of Wentworth Heights LTC Home 1620 Upper Wentworth Street, Hamilton, ON Canada L9B 2W3 email:    mvanderhorst@oakwoodretirement.com tel:     905.541.0656  fax:     905.575.4450     LTC Best Practice Resource Centre: www.rgpc.ca Donna Scott, RN, BScN, CHRP www.shrtn.on.ca Regional Best Practice Coordinator Long-Term Care Southwest Region-Ministry of Health and Long-Term Care Parkwood Hospital 801 Commissioner's Road East London, ON Canada N6C 5J1 Email: donna.scott@sjhc.london.on.ca Tel: 519-685-4292 x42337 . February 2008 Central South/South West Best Practice Coordinator in Long-Term Care Initiative