Oral Health Care Oral Health Care Training & ToolkitTraining & Toolkit

Managing oral care for the frail and Managing oral care for the frail and elderly in residential homeselderly in residential homes

Sarah Peckham – OHP Co-ordinatorSarah Peckham – OHP Co-ordinator

Jeni Malpass – Oral Health EducatorJeni Malpass – Oral Health EducatorSolent NHS Trust Dental ServiceSolent NHS Trust Dental Service

Solent NHS Trust Dental ServicesSolent NHS Trust Dental Services

Domiciliary CareDomiciliary Care

Dental Screening for elderly residentsDental Screening for elderly residents

Oral Health Promotion Input to StaffOral Health Promotion Input to Staff

Assist care homes with OH Care PlansAssist care homes with OH Care Plans

Why develop the Training & Toolkit ?Why develop the Training & Toolkit ?

Many of us have been in to a residential care home and given “The Talk”

Advantages

Raises awareness of oral diseases/conditions

Motivates the care home staff (if only for a short while)

Disadvantages

Difficult to measure outcomes

Practically impossible to evaluate

Improvements in carers’ oral health but not necessarily for residents

What the “new approach” aims to achieve:

Carers able to:

Demonstrate the use of an oral health assessment tool

Use the tool to identify the individual needs of residents

Develop and document individual oral health care plans

Demonstrate that they can provide the appropriate oral care for clients requiring assistance/support

Provide evidence to meet CQC Outcomes

Care Quality CommissionCare Quality Commission

Health & Social care Act 2008 (Regulated Activities) Health & Social care Act 2008 (Regulated Activities) defines personal care as:defines personal care as:

(a)(a) Physical assistance given to a person in connection Physical assistance given to a person in connection with……(v) oral care.with……(v) oral care.

(b)(b) The prompting, together with supervision, of a person, The prompting, together with supervision, of a person, in relation to the performance of any of the activities in relation to the performance of any of the activities listed in paragraph (a).listed in paragraph (a).

What What wewe can do for can do for themthem – meeting – meeting outcomes:outcomes:Outcome 2:Outcome 2: Consent to care and treatmentConsent to care and treatment

Each resident, or an appropriate person acting on their behalf, has Each resident, or an appropriate person acting on their behalf, has to give valid consent for the dental screeningto give valid consent for the dental screening

The care home can provide evidence of this to help meet this The care home can provide evidence of this to help meet this outcomeoutcome

If any dental treatment was required after the screening, valid If any dental treatment was required after the screening, valid consent would be sought again, providing the care home with consent would be sought again, providing the care home with another opportunity to collate evidenceanother opportunity to collate evidence

What we can do for them – meeting What we can do for them – meeting outcomes:outcomes:Outcome 4:Outcome 4: Care and welfare of people who use the serviceCare and welfare of people who use the service

Staff are trained to devise individualised Oral Health Care Plans for Staff are trained to devise individualised Oral Health Care Plans for their residents their residents

This provides evidence for the CQC that residents’ individual needs This provides evidence for the CQC that residents’ individual needs and abilities have been taken into account and abilities have been taken into account

Oral Health Care Plans are based on published research evidence Oral Health Care Plans are based on published research evidence

What we can do for them – meeting What we can do for them – meeting outcomes:outcomes:Outcome 14:Outcome 14: Supporting workersSupporting workers

Staff who complete the Oral Health Care Training are given a Staff who complete the Oral Health Care Training are given a certificatecertificate

This enable care homes to provide the CQC with evidence that staff This enable care homes to provide the CQC with evidence that staff have skills relevant to the taskhave skills relevant to the task

Provides evidence that carers are keeping skills up to date in order Provides evidence that carers are keeping skills up to date in order to continue to carry out their role effectivelyto continue to carry out their role effectively

What we can do for them – meeting What we can do for them – meeting outcomes:outcomes:Outcome 6:Outcome 6: Co-operating with other providersCo-operating with other providers

Supporting residents to access other health and social care servicesSupporting residents to access other health and social care services

- allowing dental staff into the care home and facilitating care at - allowing dental staff into the care home and facilitating care at local clinics when appropriate local clinics when appropriate

The care home can provide evidence that any information that The care home can provide evidence that any information that needs to be shared (e.g. medical history and DOB) is done so in a needs to be shared (e.g. medical history and DOB) is done so in a confidential manner confidential manner

Oral Health Care ToolkitOral Health Care Toolkit

The Toolkit contains:The Toolkit contains:

• IntroductionIntroduction

• Assistance for meeting CQC outcomesAssistance for meeting CQC outcomes

•Staff’s role in supporting residentsStaff’s role in supporting residents

•Introduction to oral health assessments and care plansIntroduction to oral health assessments and care plans

•Communication tipsCommunication tips

•Routine and planningRoutine and planning

•Oral care productsOral care products

•Referral guideReferral guide

•ResourcesResources

The Training :The Training :

• Background knowledge to dental Background knowledge to dental diseasesdiseases

• Choosing appropriate oral health care Choosing appropriate oral health care productsproducts

The Training :The Training :

Hands-on tooth brushing competencies - step-by-step task Hands-on tooth brushing competencies - step-by-step task breakdowns for:breakdowns for:

• Brushing with a manual tooth brushBrushing with a manual tooth brush

• Brushing with a powered tooth brushBrushing with a powered tooth brush

• Denture careDenture care

Brushing someone else’s teeth with a manual tooth brush. Task Break Down.

1. Gather items for tooth brushing.1. Gather items for tooth brushing.

2. Squeeze a pea sized blob of toothpaste on 2. Squeeze a pea sized blob of toothpaste on to theto the

toothbrush. toothbrush.

3. Ask the resident to relax their lips and 3. Ask the resident to relax their lips and cheeks.cheeks.

4. Work from the front of the mouth to the 4. Work from the front of the mouth to the back.back.

5. Concentrate your brushing on one or two 5. Concentrate your brushing on one or two teeth at a time.teeth at a time.

6. Position the bristles of the toothbrush on 6. Position the bristles of the toothbrush on the part of the the part of the

tooth where the gums and teeth meet and tooth where the gums and teeth meet and brush using a brush using a

gentle, methodical approach.gentle, methodical approach.

7. Brush all surfaces of each tooth 7. Brush all surfaces of each tooth systematically.systematically.

8. Be aware of any loose teeth and brush 8. Be aware of any loose teeth and brush with care.with care.

9. Don’t avoid brushing if you notice 9. Don’t avoid brushing if you notice bleeding – gently bleeding – gently

massage the gums with the bristles of the massage the gums with the bristles of the brush using brush using

circular motions. circular motions.

10. If the resident wishes to spit after 10. If the resident wishes to spit after brushing, let them do brushing, let them do

so. It is not necessary for the resident to so. It is not necessary for the resident to rinse. The rinse. The

resident can drink a glass of water if it is resident can drink a glass of water if it is safe to safe to

do so.do so.

11. If it is through the day replace any partial 11. If it is through the day replace any partial dentures and dentures and

pat dry the lipspat dry the lips

12. If it is the evening store dentures safely 12. If it is the evening store dentures safely in a denture pot in a denture pot

with water.with water.

The Training :The Training :

Oral health assessments and Oral health assessments and care planscare plans

The Training :The Training :

Oral health assessments and Oral health assessments and care planscare plans

The Training :The Training :

Routine and timingRoutine and timing::

• Ideally oral care should be carried out at bedtime and one other Ideally oral care should be carried out at bedtime and one other time time butbut

• Realistically Realistically – often carried out in morning only– often carried out in morning only

• May be due to lack of staff, lack of timeMay be due to lack of staff, lack of time

• Maintaining consistent daily oral hygiene helps with residents’ co-Maintaining consistent daily oral hygiene helps with residents’ co-operationoperation

CommunicationCommunication between carer and resident should: between carer and resident should:

Be at a level of understanding appropriate to the residentBe at a level of understanding appropriate to the resident

Be delivered in a calm and relaxed mannerBe delivered in a calm and relaxed manner

Southampton University “Healthy Conversations”Southampton University “Healthy Conversations”

-a framework for behaviour change brief interventionsa framework for behaviour change brief interventions

• techniques to allow people to find solutions to problemstechniques to allow people to find solutions to problems

• uses open “discovery” questionsuses open “discovery” questions

• “ “How”How”

• “ “What”What”

Further resourcesFurther resources

British Society of Gerodontology training resources for carers:

http://www.gerodontology.com/BSG-OH-RESOURCE-July26-2012.pdf

Jeni Malpassjennifer.malpass@solent.nhs.uk

Sarah Peckhamsarah.peckham@solent.nhs.uk

Thank you for listening.Thank you for listening.Any questions?Any questions?