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Some of the team from Calderdale and Huddersfield Community Dental Services: (l-r) Kath Halstead, Oral Health Promotion Officer for Calderdale; Karen Ormerod, Hygienist; Lynne Cliffe, Oral Health Promotion Officer for Huddersfield, and Ian Booth, Clinical Dental Service Manager for Huddersfield. Jinni D'Cruz (not pictured) is the Clinical Dental Service Manager for Calderdale

The journey to the 2003 Focus Awards started back in 2000 for this team, when a matron from an acute medical ward at Huddersfield General Hospital approached the oral health team of Huddersfield Community Dental Service. She was concerned about the oral hygiene procedures on her wards.

At around the same time, Calderdale Community Dental Service were approached by their speech and language therapist regarding the poor oral care provision on the stroke unit at Calderdale NHS Trust.

This was not news to either of the dental service teams, but previous attempts to address these problems had been frustrated by high ward staff turnover, nursing shortages and a lack of commitment from stakeholders.

April 2001 brought about the merging of the Calderdale and Huddersfield NHSTrusts. The enthusiasm that the newly formed trust had for best practice was used along with the recently published Essence of Care document as a driver to introduce some changes.

Showing the best way to brush a patient's teeth

The oral health promotion officers met with the matron from the acute medical ward to discuss a way to introduce the nursing staff to the idea of an oral healthcare plan. This could then be applied for each patient admitted to the ward.

The matron decided that the best approach was to use an oral care plan and an oral assessment tool. To help the nursing staff implement it, the oral health promotion officers decided to develop a series of workshops for the nursing staff.

The workshops

The aim of these was to enable the ward staff to identify oral conditions and assess and care for their patients' mouths. A dental hygienist with experience of caring for acute medical patients was enlisted to help at these sessions.

The workshops referred to current evidence-based practice in relation to oral care and in particular for the dysphagic patient. The team also went to lengths to ensure practical information was covered, for example

  • identifying a range of oral conditions;

  • advice on oral hygiene techniques;

  • conditions and medications that can affect the mouth.

The first workshop was aimed at the ward sisters, in order that their support was assured for subsequent sessions which took place on a six-weekly rolling programme. These were aimed at qualified nurses, nursing auxiliaries and healthcare assistants who each got a certificate of attendance at the end of the workshop.

The workshops are continuing today and are held at both hospital sites.

Feedback

At each of the workshops, the team made a point of collecting feedback to evaluate the workshops. The main message that came through was for additional material to be available on the wards, to support what the staff had learned.

To answer this need, the oral promotion teams worked with the consultant oral surgeon, hospital pharmacists and nursing staff to develop an oral healthcare pack. The pack covers many topics including:

  • factors that predispose a patient to poor oral health;

  • ulcerations and candidosis;

  • oral cancer;

  • advice for a coated tongue, and

  • a booklet Making Sense of the Mouth with coloured photographs of mouth problems (written by Petrina Sweeney, University of Glasgow).

The hygienist goes through the pack with a ward nurse

The second message that the team received from the feedback was that the ward staff were unhappy about the lack of choice of toothbrushes available. They were eager to adopt their new oral care skills, but were not provided with the tools they needed to do so. To rectify this, the matron involved in the project approached the medical directorate at the trust and obtained funding for more appropriate toothbrushes and toothpastes and other pharmacy products (eg the type of artificial salivas) for all acute medical wards.

Outcomes

The oral health team have made a big impact on the work of their trust: the oral care plan, assessment tool and protocol now form part of the Calderdale and Huddersfield NHS Trust Policy, and over 200 staff have attended the workshops.

Most importantly the team have made a real difference to the comfort and oral health of in-patients on these wards.

What next?

Not wanting to rest on their laurels, the team are taking the project to the next stage which is to introduce the oral care plan and assessment tool, along with workshops and oral healthcare packs to the surgical wards, so that best practice is adopted across the whole trust.

The Focus Awards is a joint initiative between the Department of Health for England, the Department of Health, Social Services and Public Safety of Northern Ireland, Welsh Assembly Government and the British Dental Association.

If that was not enough, the community nursing, social services and local nursing and residential care homes are next on the list, with the literature being adapted to make it more appropriate to the community setting.

How the teams got involved

To participate, each entrant submitted a nomination form with documentation supporting their claims of excellence in dental patient care, specifying which category or categories they wanted to be entered for:

  • Excellence in children's dental care

  • Excellence in treating those with special healthcare needs

  • Excellence in patient information and involment

  • Excellence in creating a patient friendly environment

  • Excellence in the development of good practice