How Clean is your Mouth?

1. How Clean is your Mouth? The Altnagelvin Experience of Essence of Care “Personal and Oral Hygiene” Wendy Cross Practice Development Nurse Altnagelvin Hospital

2. Setting the Scene • Using the Essence of Care toolkit began in February 2004 in a general surgical ward • The main focus for choosing the benchmark “Personal and Oral Hygiene” was the large numbers of patients who were fasting pre and post operatively and the aim was to improve the quality of oral hygiene • It was clear from the benchmarking that the quality of care in respect to personal and oral hygiene did not meet best practice standards • As a result action plans were devised and implemented

3. Improvements • Nursing Adult Assessment now reflects a more comprehensive , individualised assessment of personal and oral hygiene needs • The Trust has adopted the use of an Oral Hygiene Screening Tool • The Clinical Management Plans have been reviewed to reflect best practice, these are easily accessible to all areas on computer desktops

4. Improvements • A flowchart has been devised to assist in the assessment of oral hygiene and the management of specific problems • The evidence and oral hygiene flowchart are hyperlinked with the Clinical Management Plan thus making it user friendly and easily accessible

9. Improvements • A review of products used in mouth care and personal care was undertaken • New products more appropriate for oral hygiene have been introduced and products which previously used but were proven ineffective have been removed • Patients satisfaction survey was carried out on new products to ascertain, effectiveness and user ability • New products for personal and oral hygiene have been made available, including patient wipes, toothbrushes, combs etc

10. Improvements • Toilet and shower facilities were not appropriate, but staff were able to use best practice in the of the redesign of the new surgical unit • Toilet signs were erected so that they were easier viewed and also single sexed • Staff re utilised staff toilet to allow patient use and staff toilet was relocated • A resource pack for all staff has been implemented and is part of the induction programme

11. Wider improvements for the Trust • A Complaints forum and Patients’ forum has been established • Both have user membership • The complaints forum is chaired by an Non Executive Director • Essence of Care is a standing item on the agenda ensuring it is recognised as a priority

12. Acknowledgements • All staff in Ward 31 previously Ward 8 Altnagelvin Hospital • Pharmacy staff • Infection Control Staff • Clinical Audit Department • Estates Department