Oral care for pts. - or lack of...

RN@34 · Sep 22, 2005

OK, in the big scheme of things this may be little, but it is bugging the heck out of me...
Do hospitals expect pts to bring their own toothpaste and toothbrushes?
I was caring for a direct admit, in current facility about a week. (I reviewed his chart the night before my clinical and noted a lack of bathing/activity, etc., so planned to assess his ability to have the care done when I got in the next morning.)
Long story short, when I asked about his routine for oral care, he said he didn't have a brush - and that no one had asked him about this since his arrival. (There was no reason - medically speaking - for him not to brush.) I got the necessary supplies and it was taken care of before I left.
Heck, maybe it is just me, but I need to brush and floss at least three times per day...growing up in a dental family has that ingrained in my brain. Once a day - maybe - on my worse, have a migraine and can't move days.
Just kind of wondering...
SJ

We supply our patients with an admit package that includes a toothbrush with toothpaste among several other things. I believe oral care is very important, but with 6-7 high maintenance patients it takes a back seat (as far as reminding or assisting them) to meds, dressing changes, etc.

BabyRN2Be · Sep 22, 2005

Most hospitals prepare an admit bag that has the necessary equipment for good oral health. It's up to the pt to chose to use it or not.

I've just completed a CNA class and this was very big to our instructor. She was so big on oral care. She (an LPN) told us this story of a pt who hadn't had his teeth cleaned in ages. She said that there was "something", can't remember what, that went all the way across the roof of his mouth. She worked on it for a LONG, LONG time and when she got done, the "crusty/nasties" appeared to be the form of a dental retainer when she finally got it all out. The pt was LTC and all the other people ignored the problem with the pt's breath. After she was finished, the pt was EXTREMELY grateful to have that nasty retainter-like plague, tartar etc. gone from his mouth.

I guess this is why she's so big on oral care. Now hair washing, that's further down on her list. This wasn't stressed in our class but I know if I was in an LTC setting, I'd go crazy if my hair was not at least washed. Can't stand to have my hair greasy and/or oily. But she said that most times she won't wash a pt's hair unless they've been there more than 10 days.

SusanJean · Sep 22, 2005

Thanks for your responses. Honestly, the lack of oral care was driving me nuts but that was just the tip of the ice berg...I could smell the pt. outside of his room. (But the simple fact that no one even offered him a brush... he was transferred from another hospital.) Also assisted him w/ shower, set up for shave.

This floor has a good staffing ratio for nurses and has CNA's, too.

When I was getting ready to leave as my clinical wrapped up, I thanked this man for being willing to let a nursing student work w/ him. He got tears in his eyes, thanked me for helping him, thanked me for caring...

I didn't get to practice any "cool" skills, but learned a valuable lesson.

We have the opportunity for this class to pick the pts we will work with during this clinical rotation. Nice, huh?

Karen · Sep 22, 2005

I feel very strongly about personal hygiene care. You wouldn't believe the shock of the ER nurses one day when I washed a patient's hair while working in ER hold (patients admitted but waiting for available bed). She had been waiting for her bed for 2 days and had not had any personal care. The mouth care supplies were right there in the supply closet and the regular staff were like "where did that come from" I try to always remember Florence Nightengale (not to be corny) that nursing's role is to put the patient in the best condition to allow healing to take place. Mouth care is essential to prevent infections /inflammation and to feel human for that matter. You will be the best memory of his hospitalization.

MarySunshine · Sep 22, 2005

I work in the ICU with Pt's on vents who are pretty unresponsive. I always do mouth care at least once per shift, which probably isn't enough. It just takes a back seat to everything else. But I would never not do it at all. It's hard with these patient's because you're working around the vent tube and their tongue's are often very swollen and in the way. When I was an CNA in med-surg I was big on taking patient's dentures out and cleaning them. But, like I said, in the settings I have worked in once per shift was an accomplishment for mouth care.

SWAT_RN · Sep 23, 2005

Boy, this is one of my pet peeves too!!! I hate when pts. aren't at least offered the option of oral care, and in those unconcious, vented or NPO it's a no brainer! We recently began using these really nifty oral care kits for vent pts., evidence based to reduce significantly the incidence of VAP. Back to the walkie/talkies...have you ever gone to bed without brushing your teeth? Vomited and not at least rinsed your mouth? Been NPO for any length of time and felt like your tongue was the Saraha and a million camels had just crossed it? So whenever I find some poor soul without appropriate oral care supplies, I stomp around and make sure the PCTs are aware of what I consider and expect to be basic care. (btw, backrubs too!)

truern · Sep 23, 2005

Last week in clinical I had to apply wet warm compresses before I could UNSTICK a foley catheter to remove it!!!

NO excuse for the lack of care, imo :angryfire

SheriLynnRN · Sep 23, 2005

I work in the ICU with Pt's on vents who are pretty unresponsive. I always do mouth care at least once per shift, which probably isn't enough. It just takes a back seat to everything else. But I would never not do it at all.

Ok, I generally don't respond like this when something I read makes me yell at the computer, but this time I feel like I HAVE to say something. The current literature that I've read, and my facility's policy, clearly state that ventilated pts should get oral care AT LEAST every two hours to help prevent ventilator acquired pneumonia. It really only takes about two minutes to do, I do it at the same time that I turn my pts and reposition their ET tubes. I know that we are always prioritizing and trying to keep all of the balls in the air, but personally, I would rather stay a few minutes after my shift than neglect something so important.