In this guest blog, we hear about all the great work being undertaken by the Mouth Care Matters Programme, an Heath Education England initiative.
In many hospitals and care homes all over the country people are experiencing poor overall health because of poor mouth care.
In June 2019 the Care Quality Commission (CQC) released the report ‘Smiling Matters: Oral health care in care homes’ which highlights unacceptable levels of care including a lack of training and issues accessing a dentist.
How would you feel if your mouth was so dry and sore that it stopped you from eating and drinking? or your teeth hadn’t been cleaned for days, Oral bacteria flourish in the absence of regular mouth care and is a known cause of aspiration pneumonia.
Severe toothache, mouth ulcers, dry mouth and oral infections are common in these vulnerable groups and impacts on well-being and dignity, the ability to eat and to communicate.
Many people due to cognitive physical impairments are unable to clean their mouths or dentures and require support from health care professionals and carers. This is particularly more important with the aging population and keeping their teeth longer.
People may be very frail or resistant to personal care so cleaning mouths can be challenging. Nursing staff and allied health care professionals often do not have training so they may lack the knowledge and skills required to provide effective mouth care.
Mouth Care Matters (MCM) is a Heath Education England initiative to improve the oral health of patients in hospital through education and training. The program was developed at East Surrey Hospital, before being rolled out across all 13 trusts in Kent, Surrey and Sussex and a further 60+ hospitals across England have also attended training to launch the project In their trusts.
Through working with patients and front line staff we found that there was a general awareness towards the importance of mouth care but staff lacked the necessary skills with less than 40% having had training.
Most hospital wards did not stock appropriate mouth care products and oral care was recorded in less than 5% of nursing notes. Patients often had very dry mouths that were dirty and covered in secretions and debris leading to pain, infection and ulceration.
It was often the most vulnerable groups such as those were not orally fed or who were at the end of life who had the poorest oral care.
Our investigation into accidental loss of dentures if extrapolated would mean approximately 9,500 dentures are lost in NHS hospitals in England every year, costing the NHS in the region of £1 million. Much of this is preventable.
What did we do?
We recruited mouth care leads in 13 trusts to make key changes including implementing a mouth care policy, introducing an oral health recording tool, providing ward based and classroom training sessions and ensuring wards stocked appropriate products for mouth care.
It was important to engage and gain support from all hospital staff and make it a team effort. For example we raised awareness amongst hostess staff about being vigilant for dentures left on meal trays, provided hands on bed side training for nursing teams and educated doctors on how to manage common oral conditions.
Outcomes for both staff and patients has been very positive with big improvement in mouth care recording and patient care.
“I have been a nursing assistant for over 10 years and have never had any mouth care training. I have learned so much like how to remove dried debris and how to suction the mouth, I never knew it could help prevent pneumonia”.
Kay, Nursing assistant
“When my father was dying, his mouth became dry and really smelly, he was always really proud that he had all his own teeth. The nurse who cared for him had recent training and showed the other nurses and ourselves how to help keep his mouth clean. We feel it made a big difference to how comfortable he was during his final days.”
Daughter of patient
Oral health needs to be a priority for vulnerable groups, and it is fundamental that oral health training is mandatory for all staff that care for others, whether this be in a care home, their own home or in a hospital. Dental services for people in care homes needs to be commissioned and this should include domiciliary care.