Oral care

[newtress, LPN]

Hi all, I am curious to see if this may just be the norm in a lot of facilities. I am in my second level of NS in clinicals and have noticed in several facilities all the patients I am assigned to have such awful oral higiene. I was a registered dental assistant for many years before getting into nursing and I automatically incorporate oral hygiene into the daily bath care. All my patients state that they haven't had any done since they have been in the hospital or that it is rarely done. Some have been in x2 weeks and when I look inside the mouth, it is evident that there hasn't been any brushing, gingiva swollen and very coated tongues. Perfect breeding ground for bacteria/infections. Is it just a very low priority? I haven't had one patient refuse to have oral care or at least a nice rinse.

[leslie :-D]

we're pretty meticulous about po care, mostly because our pts are dying, have been w/o po intake for long periods and try to keep them as comfortable as possible.

in the hospital, i would think that many of the pts, are capable of brushing their own teeth.

in addition, where pt loads are barely manageable, i've heard nsg state, "pits and peri" as the priorities in am care.

heck, i think about these pts with gaping stage III/IV decubs, and wonder how hard would it have been to repo them?

such an easy intervention, yet that often falls by the wayside, producing major complications.

and so, no, i can't see po care being in the list of priorities.

and you're right.

how long does it take to swab a mouth with a toothette?

but given all the other issues, mouth care isn't going to be on the top of the list.

leslie

[MikeyJ, RN]

Patients that are not capable of doing their own oral care -- I then will definitely do oral care on them.

However, patients who are fully capable of doing their own oral care get no assistance from me other than providing them with the supplies to do so. I think adults need to have some management over their own care when in the hospital.

[Virgo_RN, BSN, RN]

Most of our patients are capable of doing their own oral care. We provide them with the supplies. Many have dentures and perform their own mouth cleansing rituals. Those that are incapable of doing their own oral care have it done with AM and HS care, and as needed. Every great once in a while, it does fall by the wayside when we get slammed.

You'd be amazed at how many patients who are perfectly capable of doing their own bathing and oral care choose not to. Sometimes we have to "encourage" them because they're getting stinky.

[AlabamaBelle]

It's a little different for me - work in ICU with a lot of vented patients. Meticulous oral care is a major part of our VAP prevention bundle. We are required to do mouth care q4h. It's something that I tend to do q2h though, just because it seems to make sense to at least suction the mouth out and a little swab out of the oral cavity since the patients can't swallow for themselves.

[nrsang97, BSN, RN]

If my pt is intubated I do oral swabs q1-2 hours (I work neuro and neuro breath is terrible). We also use chlorhexadine oral rinse q 12 hours. I then use the swabs with sxn that have a mouth wash with them.

If confused I will do my best but sometimes they fight and then it is the best I can.

If non intubated I will brush teeth at the end of my bath. I will assist them to if they aren't able to do themself.

If alert and oriented I will provide supplies and they can do themself.

[pagandeva2000, LPN]

Hate to say it, but this happens often in the places I have worked.

[newohiorn, BSN, RN, EMT-P]

I work in neuro ICU now with a lot of vented patients so oral care is done meticulously--q2.

However, I used to work on a surgical floor where 99% of the patients were perfectly capable of doing their own oral care and the toothbrush and toothpaste were always supplied immediately postop. I would expect a normal person to want to brush their own teeth and I left that up to them.

[Dental Hygienist]

I have often wondered about this myself being that I have a dental background. I know that patients who are perfectly capable, in their mid forties, living at home, working a full time job etc. often neglect their oral hygiene and so I shudder to think at what I will discover when I do my nursing home rotation in NS where the patients may be incapable of performing their own ADLs, may be unmotivated, or may be confused. I'd imagine that it is easy for Oral Care to fall far down on the list of things for nurses and CNAs to do in a ALF because it seems they are so overworked and chronically understaffed. I mean if I had to choose between taking a much deserved 5 minute break or doing oral care on a resident who hasn't had it in many, many days....it would be a tough choice....and I even have a dental background.

[woody62, RN]

I spent twenty-one days in an ICU. Initially, I was somewhat confused and in and out of conciousness. But one of the things I remember the most was the initial lack of oral hygiene. I asked for several swabs, in an attempt to clean my own mouth but failed. My nurse finally saw my struggle and initiated oral care. After that, I rarely had to remind any of the staff of my need for oral hygiene. No, I was not entubated but I was a mouth breather, with a large NG tube down my throat and NPO, as well as being dehydrated. It makes no difference if a patient can or cannot do their own oral hygiene. As a student and as a graduate nurse, it was my responsibility to ensure that every patient had it performed for them or by them. And if they were too ill, too tired, too medicated, too confused, it was my responsibility.

Woody:twocents:

[newtress, LPN]

I concur. :heartbeat