Educating Critical Care RNS in Using a Bedside Oral Health Exam

Abstract

Background: The methods and frequency of oral care implemented by ICU protocols varies between facilities and sometimes even between units within a facility. It is common that these protocols prescribe a set method and frequency of oral care in a one-size fits all approach. Evidence suggests that a nurse-driven oral care protocol based on the data derived from using a bedside oral health exam can reduce VAP, increase nursing role satisfaction, and save money in supplies and improved patient outcomes. Objective: The purpose of this project was to introduce a bedside oral health exam and obtain feedback on staff’s perception of implementing an oral care protocol based on the assessment. Education enhancing the current-standing oral care protocol was also included to enrich nurses’ effectiveness in the oral care they currently provide. Design: Descriptive study completed to determine ICU nurses’ perceptions of an oral health assessment-driven oral care protocol for mechanically ventilated patients compared to their current protocol and to emphasize the importance of mechanical oral debridement and maintaining proper mouth moisture. Rounding individualized education was presented as a narrated PowerPoint presentation. Setting: Maricopa Medical Center trauma, surgical, and medical ICU units in October 2019. Participants: 31 full-time ICU nurses at MMC in Phoenix. Measurements: Nurses were administered a knowledge-based three question pre-test to validate need for education and given a six question post-education survey in a 5-point Likert-scale style questionnaire. Results: The average total score for the pretest was 24.73% overall and only 6.45% correctly answering knowledge questions regarding oral care frequency, and proper intervention for foul smelling oral secretions. The survey responses regarding perception of benefit of this program had a mean score of 4.62 with ‘1’ being strongly disagree and ‘5’ being strongly agree. There were no disagree responses and only nine total neutral responses out of 186. Conclusion: The data validated that there was opportunity to enhance knowledge in the proper implementation of oral care. The survey data showed strong favorability among nurses and indicated a readiness to adopt an assessment-driven oral care protocol and felt it would be beneficial to patients by reducing VAP rates and would increase nursing compliance and role satisfaction.