Working to standards of good practice

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1. Training

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Knowledge Oral Health Care require that sufficient training to staff has been carried out demonstrating that you have embed your learning into practice.  Training will ensure that all staff have a good understanding and awareness of the relevant guidelines.  

Staff need to recognise poor oral health, how to improve and effectively manage it through education and collaboration. Staff will have a more positive view of the importance and value of good mouth care.

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Training in oral health should be a mandatory component of regular training and covered in the induction as stated in the Key Line of Enquiry question 1. [E5].

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Quality Assurance checklist for training in Oral Healthcare

 

Training in Oral healthcare should be relevant to the carer’s role at induction and thereafter an ongoing basis.   Both Skills for Care and CQC recommend this training as mandatory.

How often should training be carried out?

• Skills for Care recommend that an assessment on one’s knowledge and competence should be carried out annually.

 

The training should include:

• The importance of mouth and denture care for oral health and overall health and wellbeing.

• Know how to carry out an oral health assessment [ to include soft tissue findings] and when to reassess.

• Know how to carry out daily mouthcare to include denture care.

• Up to date information on palliative and end of life mouth care management

• Tips and coping strategies for people that resist mouthcare.

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2. Appointing an oral care champion

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The oral care champion is the person that we will correspond with. Choose a staff member that has an interest in the topic!

This person will be required to:

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1. Evidence Oral Care Training.  Be responsible for ensuring staff have training in oral health, particularly new staff.

 

2. Ensure that all resident’s oral health needs are assessed and planned in line with the NICE guidance and to ensure appropriate communication between the care home and a dental profession.

 

3. b. display reminder charts

 

c. appropriately refer residents to the dental team rather than a GP and integration with other health and social care professionals

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d. make better product choices e.g. size of toothbrush, appropriate toothpastes and dentures cleaning aids.

e. allow service users to give feedback on the quality of mouthcare support they receive (if appropriate).​

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3. Oral Care Policy

We will review your oral care policy if you have one in place.  We can provide you with an oral care policy template.

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An oral care policy should set out plans and actions to promote and protect residents’ oral health. [Your duty of care in relation to residents' oral health needs and access to dental treatments].

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• This will include signposting to local dentists.  Ideally every service user should be registered with a general local dentist.  We understand that this can be difficult with some dentists not taking on new patients and not offering a domiciliary or out of hours service.  We aim to seek and support you with finding a local dentist and/or community dental services.

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 [This is in line with the CQC’s aim of achieving a collaborative approach].  

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• Included in your policy should be ‘What to do if someone refuses toothbrushing’. Training focuses on ways to encourage individuals that decline toothbrushing to coax them to brush their teeth, how to support them and try again later or document and attempt another time.  It should include what to do if a service user continues to decline toothbrushing.

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4. Oral health assessment

An oral health assessment prior to provision of oral care should identify patient needs and facilitate targeted oral care interventions.

An Oral Health Assessment will need to be carried out on admission of every new service user regardless of how long their stay.  This will likely involve the service user’s family during the care planning process. There are a number of oral health assessment templates that can be used.  We are happy to provide our template. 

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Electronic assessment systems are popular and used in many care facilities. If you carry out oral health assessments electronically, we will review the assessment system to ensure it meets criteria and leads to an appropriate care plan for individuals.  If the system does not meet the guidance, we may require your system to be adapted accordingly.

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• Document how day-to-day dental hygiene is maintained.  Any steps taken to assess, maintain or support a service user’s oral health should be documented.

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• Assess the cleanliness of mouths of dependent people. Photographic evidence may be used. If this proves to be useful it may contribute to assessing whether the evidence leads to improved levels of cleanliness.

 

5. Recording Mouth Care Needs in Care Plans

The assessment leads to an individual care plan, designed to support good oral hygiene.  Service users are referred to the dental team if necessary.

Oral health care plans should be reviewed every six to 12 months and should identify the resident’s dentist, together with details of their routine check-ups and the outcomes of each one, as well as confirmation of whether they are exempt from NHS dental charges. Where a resident is not exempt, a plan will need to be in place to deal with how those costs will be covered.

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6. Supporting daily mouth care

Ensure that residents have toothbrushes, toothpaste, and any other dental hygiene products such as denture fixative, denture pot etc. Electric toothbrushes are charged and working. Record that mouth care has been carried out or not.  If toothbrushing could not be carried out, then indicate and give the reason eg. Declined, asleep.   If toothbrushing has been declined make a note and ideally return later.

If someone keeps refusing toothbrushing this needs to be escalated to a healthcare professional.

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Demonstrating Best Practice

If you have implemented any 6 of the 10 listed below we will award Best Practice certification

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1. Training [KLOE oral health questions "do all staff have training in oral healthcare?"

2. Mark dentures

3. Photographs - providing evidence is crucial in demonstrating best service  and quality improvement

4. Register all service users with a dentist

5. Have a dedicated information board. Hold update/progress meetings

6. Person centred care (video prompt)

7. Colour coded brushes to indicate if individual can brush independently, requires prompting or assisting

8. Renew toothbrushes every 3 months or before if bristles are splayed. Discard toothbrush after an illness [eg. flu/COVID-19]

9. Have Information on NHS dental charges (exemption?) and what’s needed to facilitate a dental visit

10. Feedback from service users about the level of care provided