Implementing and sustaining evidence-based practices in long-term care.

Strategies to implement an oral care program

By Tracey Roy, RN DOC, Connie Wood RN, BScN, MN

Centennial Place Long-Term Care Home, Millbrook

When choosing a Long-Term Care home, few people think about the level of oral care.  Does it matter?

“I reflect on this question a lot, “says Tracey Roy, Director of Care (DOC) at Centennial Place in Millbrook. Roy, who has a special interest in oral health, admits this passion spills over into her practice. She has a vision of building a culture where a holistic approach is taken towards oral care. “When I walk around the home, I watch and speak to families, residents and staff about how oral care is done”, says Roy. “I hear varied views and realize oral health is not an easy part of care. We have thoughtful staff and processes in place,” says Roy, “but, meeting the needs of cognitively impaired residents can be tough”.

Eager to improve the quality of oral care for the residents Roy asked Connie Wood, Long-Term Care Best Practice Co-ordinator to come to the home. In October 2017, an inter-professional team reviewed the best practice guideline Oral Health: Nursing Assessment and Intervention.  “Connie supported the team to conduct a gap analysis helping us to assess our current practices”, says Roy. “We formed an inter-professional oral care team to select the main concerns and we prepared an action plan”.

In November 2017, there was a 64 per cent return rate on a survey done, which gave improved data about staff values and learning needs.  Explains Roy: “The information led to a heightened awareness of oral care needs in the home, and now we are ensuring that all of our staff focuses on this area, with special attention given to new hires during orientation.  Eighty-nine per cent of the PSWs at Centennial Place have received training on oral care best practices. Families learned about the home’s project through newsletters and family information sessions.”  

So what was the biggest change in providing oral care at Centennial Place? “Focused assessments and referrals to the hygienists have been “improved", says Roy. “A tool, designed in-house by the team is set right into resident assessments and is part of the electronic chart. At this time, we assess oral health on admission, quarterly and with major health changes.”

“There have been challenges along the way”, Roy explains. “We need to be mindful about using the same language within the inter-professional team and to provide the best possible care to residents with responsive behaviours. We are moving forward with a plan to teach our registered staff on common language and assessments in collaboration with the dental hygienist.”

“The new program is working”, Roy reports – for everyone. Eighty-five percent of the residents have had a baseline assessment done by a dental professional. From these baseline assessments, 32.8 per cent were referred for further care. Out of the initial referrals, 50 per cent received two or more follow up visits with the hygienist. Now, all new residents receive a thorough oral assessment from a registered staff member and a referral to a dental hygienist where appropriate.

So how did Centennial Place achieve success to put into action the oral care best practice guideline? “I believe the success of the project is because we were able to raise awareness and the profile of oral care in long-term care”, says Roy. “This awareness nicely complemented our staff’s high standards and passion for quality care. Oral care is not seen as an extra, but part of daily life and is entrenched in the culture of the home.

What is next for the oral health care project? “The focus will keep on by linking oral care into our Montessori and restorative programs”, reports Roy. “These programs assist residents to enhance their health and wellness. Oral care fits nicely within these models”.

--About Centennial Place Long-Term Care Home--

Centennial Place is a long-term care home owned and managed by AON Inc. It is nestled in the rural community of Millbrook located in the Central East Local Health Integration Network. It is home to 128 residents, with  a high number of residents with a diagnosis of Dementia.