Title : Brush up on care: Improving oral hygiene compliance on a medical-surgical unit
Abstract:
Oral care is a vital aspect of quality bedside patient care. It contributes to comfort, infection prevention, and improved overall health outcomes in hospitalized patients. In a mid-size community hospital, the Speech and Language Pathology (SLP) team and medical surgical (med/surg) nurses (RNs) work closely together every day. Both teams identified gaps in oral care practices on the med/surg inpatient units and partnered to create a quality improvement project focused on improving oral care. Baseline assessments included pretest and pre intervention audits focused on three areas: oral care documentation in the electronic health record (EHR), availability of oral care supplies at the bedside, and the cleanliness of the patient’s oral cavity. These assessments were completed prior to the implemented interventions and showed an average pretest score was 75%. Bedside RN superusers conducted pre-invention audits over three weeks on patients with a length of stay greater than 24 hours to gather baseline data. The audit included a chart review to confirm oral care was documented every 12 hours or every 4 hours if clinically indicated, followed by a bedside check for supplies, and an assessment of the patient’s oral cavity. A total of 53 audits were completed. At baseline, documentation compliance was 43%, supplies at the bedside were 73.5%, and clean oral cavity was 68%. General education was then developed based on the pre-intervention of findings and provided during staff meetings and shared governance meetings. The interventions included were bedside audits, the creation and distribution of an Oral Care Educational Reference Guide (located on every Workstation on Wheels, Unit Communication Board, and Nursing Stations), targeted education and ongoing feedback. After every audit, real time feedback and at the elbow education were provided to the primary RN and Patient Care Associates. Following education, nurse superusers completed the same EHR and bedside audits on 118 patients over three months. Post intervention audits were conducted biweekly, with ongoing feedback and real-time support. Recognition of staff excellence was encouraged through a “Golden Toothbrush Award” program.By the third month, documentation improved to 80%, supplies at the bedside increased to 90%, and clean oral cavity improved to 95%. Monthly data showed steady improvement, reflecting successful adoption of education and increased staff awareness of oral care best practices. When the test was given again after three months, the average score improved to 95%.This project highlights the effectiveness of combining education, regular auditing, and continuous feedback to improve oral care practices in the inpatient setting. The positive outcomes support the importance of interdisciplinary care, incorporation of ongoing monitoring and reinforcement strategies to sustain improvements and promote high-quality patient care.
