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

Oral Care Quality Improvement at Friendly Manor

By: Rebecca Vansteenbergen, Assistant Director of Care  

Friendly Manor, Deseronto

Given the current staffing crisis in the long-term care sector, it has been challenging for our personal support workers (PSWs) to meet all the daily basic care needs of our residents.  We started to see a decline in some of our residents’ oral health due to a lack of adequate oral care and we realized we needed to do better.

The first question we asked was how do we improve the overall oral health of our residents?  Collaboratively, the managers and front line staff discussed the first step we needed to take. We contacted our RNAO Long Term Care Best Practice Coordinator, Lee Mantini, because she has provided outstanding support for the implementation of evidence-based best practices within our home. We arranged a meeting to do the oral health gap analysis together.

The leadership team at Friendly Manor were really pleased that so many of our staff wanted to participate in this particular gap analysis. Many were PSWs who had never been involved in a gap analysis discussion or a quality improvement project.  This was a great opportunity to empower and engage our staff. We have found that completing the gap analysis tool is the best way to review our current practices. It allows us to see what we can improve on and to acknowledge and celebrate what best practice recommendations we are already meeting.

We completed the oral health gap analysis in May 2019. We reviewed our current practices and identified some of the priority areas that needed improvement. After the gap analysis, we went online and accessed the RNAO LTC toolkit. We found many valuable resources and tools that we needed to implement our practice changes.  With our toolbox full and our staff on board, we were ready to get to work on improving the quality of oral care in our home.

First, we developed a team to lead the quality improvement project. Lucy Bedore an HCA, Nadine Way, a PSW, and Stacey Maracle an RN were the project champions and led the team. They were the cheerleaders who got staff motivated and involved. They were also instrumental in planning, educating and implementing the practice changes with the staff.

“We really got to know what each resident needed and wanted when it came to oral care and we now provide this. It’s a solid practice, even when we have staffing shortages,” explained Lucy.

During the implementation phase, we reviewed and revised our current policy and implemented an oral health admission assessment.  The resident’s oral care history and preferences are now incorporated into the ‘Getting to Know You’ tool, on admission.  All new residents to our home are given a brochure on oral care and a list of dental professionals that visit our home.  We have given each resident their own oral care kit, using the colour coded dental cards from the ‘Brushing up on mouth care’ resource in the RNAO LTC Toolkit.  Each oral care kit is individualized for the resident’s specific needs. For example, some residents now have Sensodyne toothpaste, others have pediatric toothbrushes.

At Friendly Manor, we are always striving to provide seamless care for our residents. One way we have tried to achieve this, is by reaching out to our community partners for assistance.  One of our community partners is Cindy McQueen, a registered dental hygienist, who has been working in Kingston, Ontario since 1989. Cindy now provides dental hygiene for some of our residents, in a compassionate, thorough and gentle manner. She also helps us with educating our staff, and our residents and families about dental hygiene.  With her knowledge and her long term care experience, her education sessions have been very well received.

Throughout the implementation of the oral health best practice guideline, our staff has developed many new leadership and quality improvement skills. We acknowledge that practice change is an ongoing process.  Although we have received positive feedback from residents, family members and staff, we will continue to monitor and evaluate the success of our evidence-based practice changes and plan ways in which to sustain these changes over the long term.

PDF: Oral Care Quality Improvement at Friendly Manor