1. Saskatchewan oral health Coalition
Fall 2018
Updates and 12month
Evaluation Report
Better Oral Health in
Long Term Care
2. Teaching and
implementing
BOH program into
another few new
LTC homes
&
Oral Care Kits being
put together for all
the residents
Rosthern
Middle lake
3. Traveled to LaRonge to introduce the BOH program to their LTC HOME
as well I trained the LaRonge Oral Health team for training the trainer!
4. Better Oral Health in Long Term Care
Class Room settings
for the Continuing
car aide courses
Sherbrooke’s own CCA’s
course
Sherbrooke’sCCA students are placed
at Sherbrooke and Central haven
homes
Saskatoon Business College
Urban and Rural classes
Continuing Care Aide’s Courses
5. Better Oral Health in Long Term Care
“ALL ABOUT ME”
Oral Health section added to “ALL ABOUT ME “ Document found in the LTC
resident’s charts
6.
7. Better Oral Health in Long Term Care
NEW BOH in LTC Review and Quiz added to the Annual Review Fair
“ARF”
There is a this link for you to clink on to find the BOH quiz on the LTC Annual Review fair.
• You just have to log in and the BOH in LTC come out for you to look at what SCC has
put together for the staff
• This is how you would get there, if you started on the info-net page for our Saskatoon
Area
• On the left hand side under Featured links /Clink on the E- learning /LTC/BOH in LTC
• https://learning.saskatoonhealthregion.ca/course/view.php?id=387
Annual Review Fair for staff in LTC
8. Better Oral Health in Long Term Care
Surveys are completed each year by resident’s and families
There has never been a question about Daily Oral Care
When they choose to fill out a survey their identity will not be known.
Results provided back to the home so improvement plans can be
developed.
Oral health Question we have asked to be added to the questionnaire for 2020-2021
Question: I am offered and I receive the assistance I need to ensure my
daily oral care is provided each and every day
The Annual LTC Resident’s Survey
9. Better Oral Health
in Long Term Care
“Did you know?”
Articles for Seniors health
and Continuing care
10. Better Oral Health in Long Term Care
Huddle Talks
Oral Care – Responsive Behavior
Care givers are reluctant to provide oral care because of
many reasons:
❑Not enough time
❑Not the right dental supplies
❑Fear of being bitten
❑Challenging behaviors
❑Lack of confidence that oral care is being done properly
Your Home does have the right dental supplies, please make sure you know where they are stored
Oral Health & Responsive Behavior Strategies:
• Use your Gentle Persuasive Approach and Purposeful Interaction skills
• Timing of daily oral care may have to be adjusted to achieve daily care some times 2 care givers
are needed
• Develop ways to improve access to the resident’s mouth: overcoming the fear of being touched,
modeling, hand over hand, distraction, and/or alternative provider
• Be mindful of your body language – ensure it’s approachable.
• Establish effective verbal and non-verbal communication
• Treat your residents the way you would want to be treated. It’s not acceptable to skip mouth care
just because the resident does not request it.
• Take the time to figure out what is bothering the resident
Oral health is as important as skin integrity in protecting the body against infection.
When this defense barrier is broken because of poor oral health, the bacteria in
dental plaque can enter airways and the bloodstream causing:
Pneumonia, Heart attack, Stroke, Lowered immunity, Poor diabetic control
Huddle Talk #4
For more information please contact:
Kerrie Krieg CDA – 306-655-431
Kerrie.krieg@saskhealthauthority.ca
Oral Care – Dentures
Did you know?
• Many oral health problems can occur in residents who wear dentures if Oral Care is not
done. Oral Care needs to be a priority!
• If dentures are not removed, allowing for the tissues to rest, infections such as thrush,
or denture sore mouth can develop.
Recommended Daily Denture Care:
• Brush dentures with a denture brush morning and night
• using a mild soap (suitable to use hand washing soap provided by the LTC home, Do
Not Use regular Toothpaste as it will scratch the dentures)
• Rinse dentures well under running water after cleaning them.
• Brush gums and tongue with a soft toothbrush morning and night to stimulate the oral
tissues. Cleaning dentures is not sufficient: both the dentures and the person’s mouth
must be cleaned.
• Best practice is to take dentures out of the mouth overnight, clean and soak in cold
water. If resident does not like their dentures out over night, encourage them remove
dentures for few hours during the day to rest their oral tissues.
• Disinfect dentures once a week with a disinfectant tablet (ie: Poly dent). Paying careful
attention to the kind of tablet, as partial dentures with clasps need a different kind of
disinfectant tablet.
• Offer and encourage the resident to drink water after meals, medications, other drinks
and snacks to keep the mouth clean.
• Chart and report any unusual findings in a resident’s mouth or the denture to the RN,
RPN, or LPN on shift.
Huddle Talk #2
Questions? Contact Kerrie Krieg,
LTC Oral Health Coordinator for SHA. (306) 655-4317
11. Better Oral Health in
Long Term Care
RUH -Heart and stroke and brain injury department
12. Better Oral Health in Long Term Care
Pizza was served
and they did come !!!
• During the staff’s Lunch and
Learn sessions in the Heart
& Stoke and Brain injury
Department at RUH
• I was able to provide
teaching on the Importance
of oral health. And introduce
to the staff the new dental
care products available to
them.
Lunch and Learn teaching sessions
13. Better Oral Health in Long Term Care
RUH Stroke and Brain injury department
14. Better Oral Health in Long Term Care
Oral Health In The Hospital Setting
Replacement for toothpaste when
needed :
Perivex is an alcohol free
antibacterial non- foaming gel
Mouth cleaning gel
Replaces Toothpaste for those with an
aspiration risk or if they have trouble with
rinsing and spitting
Helps lubricate the mouth
Water based - lubricant for the lips.
Used for brushing the tongue
15. Oral Health In The
Hospital Setting
*Regular toothbrush
Soft Bristles
Small brush head
Wide handle has a soft
rubber on the grip
Handle can be used as a
mouth prop used as a
bite rest for the patient.
16. Oral Health In The
Hospital Setting
*Interproximal
tufted end tooth brush
Soft Bristles
Very small brush
head
Handle can be used
as a mouth prop
used as a bite rest
for the patient
17. Oral Health In The
Hospital Setting
To clean all 3 sides
of the teeth at
once by straddling
the teeth
Collis Curve toothbrush
Brush head is
specifically designed
with curved bristles
Available in 3 sizes
18. Better Oral Health in
Long Term Care
New Oral care product provided in all
three Saskatoon hospitals
19. BOH 12 month Evaluation Report
Better Oral Health in
Long Term Care
20. Better Oral Health in Long Term Care
BOH 12 month Evaluation Report
LTC home
Total
number
of
residents
Total number of
neighbourhoods
3 Neighbourhoods
assessed
Total
number of
residents at
(initial
assessment)
Total
number of
residents at
follow up
assessment
(6 months)
Total
number of
residents at
follow up
assessment
(12 months)
Sherbrooke
Community
Centre
263 7
Kinsmen
Village
(Houses 1 to
7)
Veteran's
Village
(Houses 8 to
11)
4th Floor
148 115 93
Sunnyside
Adventist
Care Centre
104 3
Diefenbaker
Prairie land
Riverview
104 62 51
Total 252 177 144
21. Better Oral Health in Long Term Care
BOH 12 month Evaluation Report
LTC Home Number of Staff Trained
Sherbrooke
Community
Centre
39
1 Leadership Manager of Learning and Growth/ Training and development
7 Neighbourhood Team Mangers
9 Registered Nurses
22 Continuing Care Aides
Sunnyside
Adventist
Care Centre
10
1 Director of care
1 Leadership Director of Education and Safety
1 Resident Care Coordinator
2 Registered Nurses
5 Continuing Care Aides
Total 49
22. Better Oral Health in Long Term Care
BOH 12 month Evaluation Report
12.90%
4.30%
6.45%
76.34%
Either upper or lower complete denture
Complete Denture in one arch and partial
denture in the other arch
Only partial denture
No denture
Proportion of Dentate Residents Using Dentures
23. Better Oral Health in Long Term Care
BOH 12 month Evaluation Report
Proportion of Residents with OHAT Scores for Lips
BOH in LTC program had a significant impact on OHAT scores for Lips (p-value <0.001).
There were 54.99% more residents with healthy lips
in 12 month follow-up compared to the initial assessment.
24. Better Oral Health in Long Term Care
BOH 12 month Evaluation Report
Initial assessment Follow-up (12 months)
Healthy 56.25% 79.86%
Changes 43.75% 20.14%
Unhealthy 0% 0%
0%
20%
40%
60%
80%
100%
Proportion of Residents with OHAT Scores for Tongue
BOH in LTC program had a significant impact on OHAT scores for Tongue (p-value <0.001).
There were 41.97% more residents with healthy tongue in 12 month follow-up
compared to the initial assessment.
25. Better Oral Health in Long Term Care
BOH 12 month Evaluation Report
Proportion of Residents with OHAT Scores for Gums
BOH in LTC program had a significant impact on OHAT scores for Gums (p-value <0.001).
There were 34.18% more residents with healthy gums in 12 month follow-up
compared to the initial assessment.
26. Better Oral Health in Long Term Care
BOH 12 month Evaluation Report
Proportion of Residents with OHAT Scores for Natural Teeth
BOH in LTC program had a significant impact on OHAT scores for Teeth (p-value= 0.0003).
There were 70.56% more residents with healthy teeth in 12 month follow-up
compared to the initial assessment.
27. Better Oral Health in Long Term Care
BOH 12 month Evaluation Report
Initial assessment Follow-up (12 months)
Healthy 40.28% 67.36%
Changes 52.78% 31.94%
Unhealthy 6.94% 0.69%
0%
20%
40%
60%
80%
100%
Proportion of Residents with OHAT Scores for Oral Cleanliness
BOH in LTC program had a significant impact on OHAT scores for Oral Cleanliness (p-value <0.001).
There were 67.23% more residents with healthy oral hygiene in 12 month follow-up
compared to the initial assessment.
28. Better Oral Health in Long Term Care
Healthy residents
Proportion of healthy residents (OHAT measures) at Initial observation, 6 &12 month follow-up assessments
The 2 areas that dropped back in %’s at the 12 month were oral cleanliness and Gums and oral tissues
29. How are the results on the 12 month
evaluation possible?
Better Oral Health in
Long Term Care
30. Better Oral Health in Long Term Care
Oral health Presence in the home
Filthy mouths when arriving for their dental appointments
31. Better Oral Health in Long Term Care
Oral health Presence in the home
Checking dental care kits and finding this:
Having Care Aides
clean the dental care kits
Or this
32. Better Oral Health in Long Term Care
Teaching Care Aide how to place a NEW Partial denture
33. Assisting a Care Aide with placement of the electric toothbrush to
make sure the bristles are into the gum line
34. Better Oral Health in Long Term Care
Assisting with figuring out techniques that will work
2 brush technique. One to prop the mouth open the other to brush
35. Better Oral Health in Long Term Care
Moisturizing the mouth and lips with Perivex
36. Better Oral Health in Long Term Care
Showing the care aide how to do Hand Over Hand
37. Better Oral Health in
Long Term Care
For more information, visit
saskhealthauthority.ca.
Hinweis der Redaktion
When I was asked to share about the findings of the 12 month evaluation of the Better oral health in LTC and do up -dates on the LTC oral health Coordinator Position for today’s Coalition.
I have discovered that wow a lot has happened since my last up date !! Yikes we might be here a while, while I share about SO many amazing things have been happening, This month is my 3rd year anniversary of the position I hold today. I want to start by thanking the Coalition for voting to make Oral Health in LTC a priority over 6 years ago now! I have loved watching the journey of transformations right before my eyes.
I am going to start with the up dates first then into th 12 month evaluation
Rosthern and Middle Lake are the newest homes that have invited me to their homes to have the BOH program introduced to their staff and residents
A few other homes in the city want the program started but can find the time!!!
Soon this fall I hope Nokomis and Humboldt
Duck lake has expressed interest but have not gotten back to me again
Gary my husband came along and we were able to even get out on Laronge lake thanks to Janet Gray and her husband
I have had the privilege of being invited to several Teaching campuses to provide teaching of the BOH program to their students in the continuing Aides courses
The Saskatoon Business College class is called learn as you Learn so they are working as CCA’s in LTC with no training and they go to school at the same time . I taught at the spring class as well as the fall class this fall in the urban campus and just last week I travelled to Lanigan for Rural fall class
It is fun teaching the students they are all wide eyed and bushey tailed as they listen to all I have to say
This November is my 3rd year of teaching this class for Sherbrooke
Most recently I was invited for next month to Gabriel Dumont Tech School for their 16 students
While I am in the homes making notes in the Resident’s charts about my visits I also make notes in the Communication binder so the things I write down are discuss at huddles with the staff and managers. I was shown on day at Parkridge a document called “All About me” the CCA said there in nothing in here about Oral care, a document, I asked who puts these out for the homes. They said SHACC It was just over a year ago I contacted Vanessa Ripley about an idea to I had for the Seniors health and continuing care department to consider adding an oral health section to the resident’s charts under the section called “ALL ABOUT ME !”
In the email I just suggested that this would be a great idea for capturing Oral health along with all the other daily care that goes into caring for the residents in LTC. This document is reviewed often in huddles and always in nurses reports where they report on the sections for Diet, eating an swallowing, feeding tubes, Transfers, FALLS Risk, Dressing, Mobility, Skin Care BUT NOT ORAL CARE!!! I asked them if they would consider adding this
I never heard back from them, I actually forgot about it ! till this spring I was at Parkridge and one of the staff showed me their new version of the “ALL ABOUT ME” document and all residents had to have the new ones completed by their RN’s in a very short time frame. She showed me that there was a new section for Oral care !!!” I was so excited I asked if I could have one to show my manager and she said sure ! I also took a picture !! So then I was curious was this for all the homes I went to SCC and sure enough they had this new version as well But they had added it to theirs's to make it compatible to their home’s Programs that they cover, Look at this one !
This is their version “MY LIFE PLAN” and because Sherbrooke LTC home is a sister home to Central Haven they also have this addition to these documents
Isnt that so Wonderful?
So I have since looked in Rosthern and Middle Lake and sure enough they have these sections as well.
I have brought the hard copies of these documents so you can
This was another request that I put forward to a Clinical Nurse educator at SCC and she thought what great Idea and got on it right away
I contacted the ministry of health for the request for adding this question to the survey and they said the earliest that it could be added is 2020-2021
This is what the survey say for the resident’s and families
“Please take a moment to complete the following survey. How you experience life in the home is extremely
important to understand. Your responses will be combined with others and analyzed by the Saskatchewan
Health Authority and the Ministry of Health, and the results provided back to the home so improvement
plans can be developed. Resident and family councils are welcome to review the results.
If you choose to fill out a survey your identity will not be known. Below are a number of experience
statements that you may respond to with “always, usually, sometimes, rarely or never”. If a statement is
not applicable to you or you choose not to respond, select “not applicable.”
The admin person will send these out to the LTC homes for them to use at huddles or to post in the neighbourhoods
While I was at Parkridge on day this spring a manager I had recently ben working with stopped me in the hall to let me know that he had just recently given my name and email address to the heart and stroke department at RUH . They wer looking for some help in their department with oral health. I was contacted by the managers as well as the Speech language Pathologist in charge of the Heart and S and BI department because they had heard about the BOH in LTC program being introduced into the homes as well as rumbling of my working with the SLP in LTC and how I work along side of them to help address oral care they notice is lacking for their residents. They invited me to come and show them my stuff and give a presentation. I invited Chris Gordon to come with me to do a presentation because I knew she had an interest in oral care in the hospital setting she had given an oral heart presentation in the peds department at RUH the year previous, We did our presentation about the link of poor pral health to a person’s over all health , I have adoptedsince that day Chris’s saying “What happens in The Mouth doesn’t stay in the mouth’” I also took with us all the dental care products that I introduce to the LTC homes
At the presentation to the managers I told them they could access the oral care products thru the stores department right there at RUH . They said what? We have these products in our hospital ?I said yup I will give you the SKU Numbers. They promptly ordered them up to their ward.
They arranged some Lunch and learn sessions with Pizza being served and they did come!!! 20 or more staff at each session.
At this presentation they staff were so excited to be able know this that they will have a decent toothbrush for their patients. After this presentation the unit have also up graded their suction toothbrushes fro each bed side to a patient.
I was the on the ward recently with Chris Gordon and she said Kerrie! We need a picture of you with is this Bulletin Board, this is awesome After my presentation they asked for copies of my power point slides. The staff put together this Bulletin Board for their Unit the heart and stroke and brain injury ward
They are featuring the products a well as the process for referrals for an oral health professional to assess a patient they are having difficulty with Oral care
Perivex is a used to replace tooth paste for patients that have swallowing problems and an inability to spit.
We replace the toothpaste for these patients because regular toothpaste causes:
>Foaming
>Increased saliva flow and a need to spit
>Reduced caregiving visibility
>Increased risk for aspiration
-Lubricates the mouth which is particularly valuable for those who do not receive nutrition by mouth and those with dry mouth.
- brushing tongue -to break up plaque that has adhered to the tongue.
This toothbrush has a small rounded head with soft bristles
The small brushing head makes it easy to reach most areas in the mouth.
The the most beneficial characteristic that this toothbrush has over any other is the large rounded rubber handle.
The handle on this brush provides a larger more sturdy area for a patient with decreased dexterity to hold their toothbrush and brush their own teeth, something that would not be possible with a small plastic handled brush.
The large round rubber handle can also be used as a bite rest for the patient. This provides comfort and safety to ensure the caregiver can provide a patient with a comfortable safe surface to bite on while enabling the caregiver to keep the mouth open.
While the handle is being used as a bite rest, tooth brushing with the another toothbrush that is provided for their daily care
This is a very small soft bristled brush that fits where a regular tooth brush does not.
The head on this brush measures only 5mm across and from the back of the plastic head to the tip of the bristle 15mm.
For removal of plaque and food debris in those very hard to reach areas as well as between the teeth that touch.
The handle on this brush has a large rubber handle making it easy to hold and control the brushing in those tight areas
Also for areas that are needing to be flossed but care givers are not comfortable with flossing another person’s mouth.
The soft end can also be utilized as a bite block when needed as well.
3. Kelly was referred for Chris and I to visit while we were on the unit floor by Bill another SLP.
Collis brush is available thru the Manager of the Unit of 6300
Kelly was a stroke patient and had just had surgery and while being intubated her tongue protruded and had swollen days ago while on ICU and they said there was a gash on her tongue her tongue has been protruded out of her mouth still and now swollen. Chris and I introduced ourselves to the family visiting her and Chris and I accessed her mouth. She was able to understand us we believed and we worked with her to allow us to use the suction toothbrush in her mouth on the buccals of her teeth. She is having to learn how to communicate since her stroke. We just slowly worked with Kelly and asked her to open while modeling and by demonstrating to her how to open her mouth.. As she tried to open Chris was able to massage and gently slide her one side of her tongue in-between her teeth. I then slowly massaged her tongue on the other side and I was able to get her whole tongue back in her mouth. . Bill stayed with us and watch us work with Kelly. But then he was concerned that she would not be able to breath with her tongue filling her mouth. We then just mentioned that she had a trachea and was breathing thru her nose and the trachea not her mouth. He husband and Bill were so grateful and appreciative of us coming to work with her. We all, I think just about starting crying ! it was the Friday before the Thanks giving weekend and they were so very grateful. We saw other patients and then went back to ck on her ½ hr later and she was still able to keep her tongue in her mouth. We explained as the swelling went down her tongue would return to normal size and the bite on her tongue will heal. The oral cavity heals quickly with moisture from saliva. She raised her fingers on her hand to thank us as the husband asked her to. He was so proud of her being able to communicate this to us.
It was so rewarding that day to able help this young woman in her 20’s. We then worked with her husband to show him how he could use the suction toothbrush for her.. while he visited her. Also to put Perivex on her lips to keep them moist He was excited to be able to be able to do something for his young wife while visiting her.
On Tuesday I returned to see how she was doing and all was good!! Bill her SLP was able to work with her while I was there and she was starting to receive juice by spoon and ice chips by mouth opening with prompting. She was moving the ices chips around in her mouth. Her husband was there again and thanked me again. I then showed the staff how while she opens her mouth, to place a toothbrush handle in between her teeth on one side then the other and then brush the insides of her teeth as well with the suction toothbrush.
After this unit fining out that these products are available to their unit, I have been able to get these products for all 3 hospital
Chris and I are presenting at the care aides coned class coming up this fall.
I am going to high light some of the finding that Shiddique found on the Data I sent to him
The over all results are so very good
I will often receive texts or call from the dentist or the assistant or the Hygeinist
Kerrie will please check on so and so this is what we found today !
I will either call or text my champions in the homes and ask then to address this or the manager or I will go myself depending on the time I have
Both of these homes have dentist and Hygienists
Talk about John and his story of when I found him and where he is know
Often to takes a 2 person assist for the residents like Donavan who cannot help with his care
I would love more residents like Donavan who advocate for himself They brsuh ,floss and clean his tongue daily
He will often stop me in the hall way and say Kerrie ! have a look at my teeth Are they doing oK with my mouth care???