Training the 'Carers'
Janet Griffiths
University Dental Hospital, Cardiff

SNAG Study Day
September 25th 2009
Developing In-patient
Oral Health Care Services
Screening
Oral Health Risk Assessments
Collaborative Care
Training programmes
Successes & failures
S Glam HA:  1989 - 1995
14 hospitals
4 Day Hospitals
6 surgeries
1.4  Dentists
0.7  Hygienist
No dedicated DN

S Glam HA:  1989 - 1995
In-patients:    3,000 beds
Acute admissions:    Pain relief
                 Intensive Care
                Critical Care
Lost dentures
Adult Special Care in CDS

Remit:  Annual Screening
Approx 1500 beds
Geriatric
Rehabilitation
Mental illness
MH Older People
Learning Disability
Screening Programme
Dental status
Prosthetic status
Pathology
Treatment needs
Referral to Hygienist
Report > Ward Manager
Offer training
Collaborative care
Medical team
Nursing profession / carers
Occupational therapists
Physiotherapists
Pharmacists
Dieticians
Target group:    Rehabilitation
            Cont Care
Identify need
Encourage early referral
Collaborative care plan
Oral Health Education:
    Staff training
    Standards
Communication barriers


Evidence
Diu & Gelbier 1987
Rak & Warren 1990
Quinn & Freeman 1991
Boyle 1992
Longhurst 1998 and 1999
Bowsher, Boyle & Griffiths 1999
Frenkel 2000
New approach
Hoad-Reddick 1991
Oral health risk assessments
Focus on needs of client group
Care plans
Pilot initiatives
FOCUS ON ORAL HEALTH
Day Hospital
Reduce emergencies
Access to dental care


OH risk assessment  Griffiths 1995
Check list
Dental status
Denture status
Oral problems
Access to dental care
BSDH guidelines 2000
http://www.bsdh.org.uk

Personal details
Medical problems
Social history / mobility
Criteria for domiciliary care            
Pilot study
Oral assessments
Patient contacted
Referred CDS
Analysis
Feedback
Results
Sample 185
Mean age 75
69% edentulous
37% with problems
59% no dentist
57% referred CDS


Pilot study:  outcome
Identified need
Requested training
Assessment adapted
Routine assessment
Won Health Promotion Award

    
Stroke rehabilitation unit: DCPs
Impairment / Mobility
Dental/ denture status
Oral problems
Diet
Life-style / habits


Stroke rehabilitation unit
Stressors:    Medical problems
            Hydration
             Mouth breathing
            Epilepsy
            Dysphagia
            Oxygen therapy
                
Stroke rehabilitation unit
Stressors
Medication
Manual dexterity
Dependence for OH
Registered with dentist


Stroke pilot study
Sample 16
Physical disability:        100%
Oral complaints:         37.5%
Stressors:                 43.5%
Not self-caring OH:         75%
Manual disability:         62.5%
Number of prescribed drugs
48 drugs
33% with oral side-effects
Number of scripts
84 prescriptions
37% with oral side-effects
No scripts for OH
Outcome
Advice
Side-effects of drugs
Interim care plan
Summary to Ward Manager
Include in Nursing Assessment
Requested Nurse Training
Neuropsychiatry

Acquired brain disorder (ABI)
Associated psychiatric disorder
Challenging behaviour
Day & in-patients
Adapted assessment
Assessment: DCPs
Personal details
Nature of impairment
Dental/denture status
Oral problems
Diet
Stressors
DCP lead
Interview primary nurse
Interview client
Observe client
No examination
Review medical notes
Record medication



Acquired Brain Injury (NPU)
Acquired brain injury (NPU)
Physical disability    37%
Mental illness           37%
Cognitive deficits     85%
Communication        30%
Reported problems  30%

Life style & habits
81% current smokers

81% H/O alcohol abuse
No of prescribed drugs
37 prescribed drugs
70% - oral side-effects
40% - blood dyscrasias
37% - xerostomic
27% - other

No of prescriptions
63 scripts
81% - oral side-effects
76% - blood dyscrasias
44% - xerostomic
28.5% - other

Dental attendance
4 - receiving care
2 - under GA
78% - no information
2 - no response
Outcome
Audit presentation
Agreed standards
Routine assessment
Training manual
Trust Quality Award
IADH Japan (1998)
Mental Health Older People (EMI)
Request for training
10 wards
4 locations
Single Ward pilot
Introduce assessments
Pilot care plans
Disaster !!!
Oral health risk assessments
Stroke rehabilitation
Neuro-psychiatry
Learning disability
Rehabilitation
Neurosciences
Mental Health Older People
Staff training
Formal sessions
Study Days
Informal:    Ward handovers
             Domiciliary sessions
             Appointments








Part 1:    Core Content
Scientific Basis of Oral Health Education

Part 2:    Adapted to client group
Learning disability
Mental health older people
Rehabilitation
Neurosciences
Oncology / Palliative care




Resources
Dental Hygienists
Dental Nurses
Oral Health Ward Manual
Individual Oral Care Plan


Operational policy
Referral & discharge
Lost denture policy
Denture marking
Aids to oral hygiene
Desensitisation techniques
Oral health risk assessment
Oral Care Plans
Oral hygiene protocols
Fluoride
Chlorhexidine
Saliva substitutes
Relevant reports

Oral health risk assessment
Identify individual potential OH needs
Possible risk factors for OH
Clients needing a dental service
More informed referral
Information for care plan
Feedback to multidisciplinary team
Profile of oral health needs
Screening system
Efficient use of resources

Resources
www.bsdh.org
Journal Disability & Oral Health
www.gerodontology.com
Dementia Guidelines
www.sigwales.org
Essence of Care
NSFs

Signposts
Respect for each other's expertise
Erosion of professional boundaries
Shared care
Potential benefits
Establish standards
Collaborative and
Team approach
Thank you for your attention