evidence based mouth care policy - Doncaster and Bassetlaw ...

• STAFF WHO MAY CARRY OUT THE PROCEDURE
The mouth care needs of patients are identified on an individual basis.
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REF: PAT/PA 17 v.1
Student nurses and midwives may deliver oral care to patients only under the supervision of a
registered nurse or midwife who are competent in this aspect of care and the supervisory role.
A registered nurse or midwife must carry out the oral assessment whilst health care assistants and
clinical support workers may carry out oral care, under supervision.
It is the responsibility of the RGN and Registered Midwife to assess, plan, implement and evaluate
care.
In line with guidelines laid down by the NMC (2002) for records and record keeping there must be a
current and appropriate plan of care for all patients. The plan must incorporate on-going evaluation
and reassessment of care and evidence that relevant interventions and observations have been
communicated to appropriate members of the multidisciplinary team.
Student nurses/midwives, health care assistants and clinical support workers should work through
the mouth care pack produced by the Oral Health Working Party (OHWP 2003). This pack is
available from the Training and Development Department upon request.
The following risk factors should be taken into account:
• RISK FACTORS
Illnesses
The literature consistently supports that various illnesses increase an individual’s risk of oral
complications.
* Diabetes * limited/restricted fluids
* thyroid dysfunction * mouth breathers
* oral disease/trauma * confusion
* cerebrovascular disease * depression
* debility * terminal illness
* acute/chronic breathing * poor nutritional status
disorders * oxygen therapy
* insufficient saliva production * a general lack of motivation or inability
to undertake oral hygiene
(Thurgood 1994, Regnard et al 1997, Holmes 1997).
• Other patients groups ‘at risk’
i) Patient receiving intensive care
ii) Patients receiving chemotherapy and patients receiving radiotherapy to the head and
neck.
iii) Patients receiving immunosuppressive therapy, i.e. transplant patients. (White 2000)
iv) Elderly patients – if ill fitting, then dentures should be avoided where possible. If well
fitting then dentures should be cleaned twelve hourly and removed at night. They
should be brushed with an unperfumed soap or toothpaste, soaked in a solution of
sodium hypocloride (Milton Sol, Denture Steradent for metal dentures) for 30 minutes
and stored dry overnight.