Heartbeat: Making mouth care matter

April 1, 2021

Research shows that oral care is often lacking in hospital and community care settings, especially among patients who may need support with their personal care and rely on others for support; Mouth Care Matters seeks to address this. Twelve trusts built on the findings of a study conducted in 2015 at East Surrey Hospital under the leadership of a special care dental consultant. From this pioneering work “Mouth Care Matters” was born.

In early 2020, SWB launched their mouth care pilot based on the mouth care matters guidance. It aimed to improve the oral health of inpatients across four wards at City and Sandwell hospitals. The trial involved teams receiving specific training and equipment to carry out effective mouth care on patients.

Julie Thompson, Director of Nursing, Medicine and Emergency Care told us: “Poor oral health of a hospitalised patient can lead to an increase in hospital-acquired infections, namely hospital and ventilator acquired pneumonia, as well as poorer nutrition.”

Fast forward to 2021, and we can now reveal some of the standout highlights of the trial and what the team hope to do next. Heartbeat spoke to Ru Hazarika, Service Planning and Delivery Manager who told us: “We have seen some positive results on the back of the trial we conducted last year. Some of the key highlights include a 45 per cent reduction of hospital-acquired pneumonia on our pilot wards. We’ve also seen a 29 per cent reduction in antibiotic prescribing and a 34 per cent reduction in Nystatin use.

“Patient and staff feedback has been positive too. Patients’ mouth conditions have improved. In turn, it has helped with being able to eat and drink without pain and discomfort. Colleagues have undertaken oral assessments on admission, and every seven days by rating their oral health care as red, amber or green. This insight then informs staff on the necessary oral care needed based on their oral care rating. Staff also used specially designed oral care products and equipment that assist with effective and simple approaches to mouth care routines. What makes these products unique is that the toothpaste, mouth gel and cleaning swab/brush are all in one sterile, disposable kit.”

So, how did the pilot continue when COVID-19 hit? Ru explained: “Fortunately, we were coming to the end of our trial at the time so there wasn’t a significant impact. There was also an upside to the use of the products. Evidence shows that the 24 hr kits which are designed to use with suction equipment have a significant impact on preventing ventilated acquired pneumonia which is vital in our fight against COVID-19.

“Initially, we had some challenges implementing the changes so soon after moving to Unity. Working with clinical support managers in IT, we are in the process of being able to make some small and helpful changes that will lead to us effectively documenting daily oral health care routines in the future.”

The team will now be submitting a business case and intend to roll this initiative out across our organisation. Ru explained: “A multidisciplinary working group is in place to support the implementation and roll out once approved. Ensuring the initiative is sustainable requires active involvement with our dieticians, speech and language therapists and our infection prevention and control team to name but a few.

“The initiative is part of the weLearn poster competition, and we are now in the final ten. We’ve also presented our findings to the Learning from Deaths Committee and Pneumonia Taskforce. In September 2020, Health Education England asked us to present at the regional webinar forum for mouth care matters as an example of good practice in running a pilot.”

Ru added: “I must say thank you to everyone involved in this project. It came about as a result of collaborative working across different areas including our GDON of Medicine, Julie Thompson, Janice Nelson, Clinical Procurement Nurse Specialist, Stryker, our Mouth Care Matters Fellow from Health Education England, Jaffer Ismail and Matrons, Sam Walden and Jo Thomas. Colleagues and ward managers on all four sites were enthusiastic and passionate about the pilot, and the results were made possible all thanks to their willingness to try something new and implement change.”