CQC Compliancy

  • Only 1 in 4 residents now safe to be transferred in a toileting sling.

    Did you know that ONLY 1 in 4 people, that’s just 25%, are now considered suitable for a toileting or access sling? - As stated by clinical advisors and senior board members of the National Back Exchange.

    Continue reading

  • Our top coping strategies to help improve oral care for your residents with a Dementia

    Our top 10 coping strategies to help you to improve oral care for your residents with a Dementia

    One of the biggest challenges we know you face, because it is one of the most frequently asked questions we get asked regarding oral care is:

    How can I deliver more effective oral care for my residents with a Dementia?

    It is fact that your residents with a Dementia are most likely to present your care staff with the greatest challenges regarding delivering effective oral care, as they are more likely to resist tooth brushing. This is often a response to fear or a previous bad experience.

    And with the number of people with a Dementia who have their own teeth expected to rise significantly, if oral care is not carried out, a vicious circle of pain and discomfort, leading to increased resistance becomes likely.

    Those people who have advanced Dementia may not be able to verbally communicate pain and discomfort in their mouths, and this may manifest itself in other ways such as crying, pulling or hitting their faces, hitting out at care staff or being very passive.

    To compound this, many carers have little or no experience of training in delivering good oral care and there is a lack of good quality, safe and fit for propose oral care product solutions available on the market.

    If you would like to learn more to enhance the oral care in your care home, get CQC ready for the new oral care quality standards, and demonstrate that your home is effective and responsive to CQC, join us at our latest event:

    Our first CPD accredited training seminar:

    ‘How to achieve CQC compliancy in oral care for adults in care homes’

    Please click on the link to learn more and book your place at this popular event

    The important thing to remember is that as with all other aspects of care, there is no standard one size fits all solution.

    A good oral health plan, in 3 stages, should be created for each resident which is specific to their own individual needs.

    Stage 1

    On admission a risk assessment should be completed to ascertain the oral health needs of your resident.

    Stage 2

    A care plan should be created from the findings of the risk assessment.

    Stage 3

    The care plan should be followed and documented at regular intervals dependant on the findings of the risk assessment and both should be reviewed at least every 12 months.

    Always encourage independent brushing where possible

    Always try to encourage your residents to brush their teeth for themselves for as long as they are able to do so, to promote their independence and dignity for as long as possible.

    Sometimes, residents will forget that they need to brush their teeth, and a reminder to brush is all that is needed.

    Some residents may be able to brush their teeth, when prompted, with some assistance. Try using the Chaining or the Bridging methods to help support your resident to brush their teeth themselves.

    The Chaining Method – Place your hand over your resident’s hand and guide them as they brush.

    The Bridging Method – Standing in front of the resident, brush your own teeth so that they can copy and follow your actions.

    For residents who are non compliant with tooth brushing.

    If you have residents who refuse to brush or have their teeth brushed, try to understand this behaviour as a sign of distress rather than thinking that the resident is choosing to be aggressive and uncooperative. Remember, this is often a response to fear or a previous bad experience.

    We do need to respect peoples’ decision should they decline from wanting their teeth brushed, however,  it is important to remember that oral hygiene is part of personal care and that brushing is not just dismissed because your resident has declined to have their teeth brushed at that time and in that place.

    Think about how you would feel if you weren’t able brush your teeth for 2 weeks.

    Remember do unto others ................ if you clean your teeth twice a day with a brush and paste, then that’s the minimum attention you should give your resident.

    Then think about how you would feel if you were reliant upon someone else to brush your teeth for you.

    • Be flexible - try prompting oral care at different times of the day and in a place where your resident feels comfortable, it doesn’t have to be in the bathroom!
    • Review the tools and products being used, are they appropriate for your resident? Look at the size of toothbrush head and strength of bristles, too big? Too hard?  Small, soft headed toothbrushes are recommended, such as our Tepe Special Compact Toothbrush.
    • Use an SLS free (non-foaming) toothpaste,  this has a tremendous benefit to your residents who have to have mouth care delivered by a carer as it will greatly reduce the risk and fear of aspiration and also take away any potential choking and gagging risk. It also allows carers to see if there are any problems in the mouth.
    • It is important NOT to wet the tooth brush as this will avoid unnecessary liquid in the mouth, and only use a pea size amount of paste, as, again, this will greatly reduce the risk and fear of aspiration and also take away any potential choking and gagging risk.
    • Always approach your resident to assist them with their oral care either from the side or at the front of them and always at their level. Try using the Chaining or the Bridging methods to help support your resident to brush their teeth them selves
    • Talk to your resident calmly and kindly, and tell them what you are doing throughout the care to help build their trust and confidence.
    • Consider also, carer preference, if there is a particular carer that your resident enjoys a good rapport with, there will most likely be able to achieve a more positive outcome.
    • Think about introducing a system of brushing, eg always start brushing from left to right so that you can monitor which teeth have been brushed if you have to split mouth care into short bursts.
    • Record oral care in care plans including refusal, so that it is documented that you have attempted to deliver that care, but it is your residents’ choice not to have it.
    • Remember that any changes in oral care that are currently being delivered need to be managed in small steps to allow your resident to get used to new ways. Small introductions of change will enable you to gauge how well things are working and how well your resident is responding to and is compliant with new introductions, workings and tools.

    And finally and above all, always remember that you are dealing with one of the most intimate areas of your resident’s body which is used for lots of lovely things, eating, talking and kissing.

    When delivering oral care - ‘Look beyond the illness and reach out to the person who needs to feel secure, respected and cherished’.

    To learn more about oral care and Dementia as well as other highly dependent and medically compromised residents, and to get QCQ ready for the new oral care quality standards for adults in care homes,  book your places today and join us at our CPD accredited seminar:

    ‘How to achieve CQC compliancy in oral care for adults in care homes’

    Please click on the link for full details of the event, which is certificated.

  • How improving oral care can lead to more kisses - case study

    How improving oral care has led to more kisses for one care home resident! XX

    Here at Hcsuk, we believe that one of the main barriers that prevent residents in care homes from receiving good and effective mouth care is a lack of availability of fit for purpose tools or products.  We wanted to demonstrate that by introducing appropriate oral care products, significant improvements to peoples’ mouth care and overall health and well being can be achieved and can lead to more love and kisses to!

    Background

    We conducted a  trial with Mr A who lives in a care home in Leicester with Advanced Parkinson’s Disease,  with no swallow reflex and who is on a peg feed and is nil by mouth.

    I met with Mr A to introduce myself and to ask him how we could help him, and he told me that all he wanted was to have a fresh feeling mouth, something that most of us take for granted, I’m sure.

    Mr A’s mouth care was described as very poor by staff, as Mr A was not able to open his mouth very well and therefore access to his mouth to deliver effective oral care was limited, plus the staff were frightened of Mr A swallowing or aspirating on the oral care products which were in use.

    Mr A had severe halitosis and a substantial build up of debris on his tongue as a result of intermittent cleaning results

    Mr A had his own teeth and didn’t have any particular issues with these at the time of the trial

    The oral care regime that was in place when I met with Mr A:

    Brushing twice a day with a normal toothbrush (large head) and standard toothpaste. This was intermittent due to the staff’s lack of confidence in the products and the risk of aspiration. Also, despite Mr A’s halitosis, staff would not use a mouth wash for additional fear of aspiration.

    Our recommendations and rationale:

    We know that a toothbrush used properly is the only tool that will successfully remove bacterial plaque from the teeth and mouth.

    For tooth brushing - we selected our Tepe Special Care Compact Toothbrush as it is very gentle with 12,000 extremely soft filaments and a small head which is more effective at reaching all parts of the mouth. This soft toothbrush was perfect for Mr A as it is recommended for patients with swelling and difficulty opening their mouths and its sturdy, ergonomically designed handle provides a comfortable and secure grip and can easily be angled for better access to all areas of the mouth.

    Toothpaste – As Mr A was at risk of aspiration we recommended our Oralieve Mild Mint SLS free Non Foaming Toothpaste.  Sodium Lauryl Sulphate (SLS) is the ingredient added to many toothpastes that makes them foam. This can have a drying effect on the oral tissues and therefore should be avoided in residents who already have a dry mouth. Similarly, for those patients at risk of aspirating, a SLS free toothpaste could also be beneficial so as to reduce this risk as far as possible. We recommend that care homes provide non-foaming toothpastes (Sodium Lauryl Sulphate (SLS) free) for patients with a dry mouth or patients who are at risk of aspirating.

    Providing dry mouth care - Dry mouth moisturising products provide long lasting relief for a severe dry mouth and can be used to soften dried secretions so that they can be removed more readily. There are different products available including gels, sprays and mouth rinses. We recommended Oralieve Moisturising Dry Mouth Gel which can be massaged into all areas of the mouth (cheeks, palate, tongue) in conjunction with an Mc3 (formerly MouthEze) oral cleanser before meals, to help with eating or before tooth brushing for very sore mouths. Dry mouth gel can be mixed with a couple of drops of water to make it more palatable to patients.

    MC3 (formerly Moutheze oral cleansers) - provide gentle mouth cleansing without the choke or aspirating hazard of sponge swabs or the awkwardness of toothbrushes and also for the application of dry mouth products. We recommended this for Mr A to clean the soft tissues of his mouth and remove food debris and tenacious dried saliva.

    The clinical results

    The introduction of the Tepe small, soft headed toothbrush with angled head and the SLS free non foaming toothpaste, resulted in the staff being able to deliver regular mouth care with confidence that the risk of aspiration was minimal and being able to access all areas of Mr A’s mouth for cleaning, easily and thoroughly.

    As Mr A had a significant build up of dried secretions in his mouth and particularly on his tongue, the use of the dry mouth gel coupled with the MC3 (Moutheze oral cleanser) enabled the staff over a period of time to work on reducing the build up and to restore Mr A’s tongue to a pink and healthy state.

    The nurses commented that the dry mouth gel has been really successful for lubricating Mr A’s dry lips and mouth and they have found the mouth area cleaner with less coating.

    The carers’ have found that Mr A’s breath is much fresher and he is communicating more as his mouth is not so dry.

    The social results

    I went to visit Mr A a month after the trial began and he was a different person to the man I first met. He was much more confident and socialising more as a result of using the products and he told me that his mouth felt much fresher and cleaner and that it didn’t feel so dry.

    Mr A’s wife visits every day and she has found that his breath seems much fresher especially when talking and he no longer has any signs of the bad breath he was suffering in the past.  As a couple they are now able to be much more physically close and are kissing as a result of his improved oral hygiene.

    Mr A and I exchanged a high five!

    If you are interested in how you can improve oral care standards in your care home to meet the new CQC Quality Standard in oral care and demonstrates that your service is effective and responsive, we are running a course on Wednesday September 20th at Jury’s Inn, East Midlands Airport:

    How to achieve CQC compliancy in oral care for adults in care homes

    For more details and how to book, please visit our event page at

    https://www.eventbrite.co.uk/e/how-to-achieve-cqc-compliancy-in-oral-care-for-adults-in-care-homes-tickets-37072200951

     

    You can also watch the video of Jo talking about Mr A below

    [embed]https://youtu.be/LCB0OBsUw0Y[/embed]

     

  • How ready are you to meet the new CQC Quality Standard – Oral Care in Care Homes?

    On 7th June 2017, NICE Quality Standard 'Oral Care in Care Homes' was published.  It recommends that residents in care homes have their oral health needs assessed on admission and recorded in their personal care plans, and are supported to clean their teeth twice a day and/or their dentures daily.

    The Care Quality Commission (CQC) expects care managers to take account of the nationally recognised guidance, including CQC Guidance from NICE, in essence, CQC want to see care homes prioritizing oral care.  Also, being able to evidence how you support residents to maintain good oral health will help you to demonstrate that your service is both effective and responsive.

    Included in the guide below are the tools to help you make those improvements:

    Improving Oral Health for Adults in Care Homes - A Quick Guide for Care Home Managers in association with NICE and SCIE -  which highlights areas for Care Managers to focus on

    We know that many of you social care managers and your staff out there know what is expected of you when it comes to supporting your residents with oral care, but due to a lack of available training, fit for purpose oral care product solutions, tools and resources, are unaware of the best practices and how to implement these.

    Here at Hcsuk, we really want to help and support you to achieve compliancy, and are therefore really proud and excited to announce that we have teamed up with Jane Peterson, RDH, BSc, Dental and Healthcare Professional and founder of oral health training company Oral Health Matters, to host:

    Our First CPD Accredited Seminar

    ‘How to achieve CQC compliancy in oral care for adults in care homes’

    Wednesday 20th September 2017

    8.30 a.m. - 12.30 p.m.

    at

    Jury’s Inn, East Midlands Airport

    £99 per person

    Including refreshments, networking opportunities, car parking and buffet lunch

    To book this course now, please go to https://hcsuk-oral-health.eventbrite.co.uk

    As well as teaching you best practice in assisting and supporting your residents on oral health matters, these best practices will demonstrate to your stakeholders that you prioritise oral care.

    Who should attend this course?

    This oral care seminar is designed for all staff who are involved in the personal care of residents, senior care staff including care managers, oral champions, learning and development leads and trainers.

    What are the course objectives?

    To raise awareness of the importance of daily mouth care for older people in residential care and to provide practical advice on oral care techniques. Carers will be provided with the knowledge and ability to plan and deliver daily mouth care within residential and nursing care homes.  This course combines the practical and theoretical aspects of our basic and advanced level courses to deliver a complete guide to oral care provision for the elderly in care homes.

    Which topics does the course cover?

    • The mouth and teeth
    • Oral health and the body
    • Daily oral care
    • Denture care
    • Oral care and dementia
    • For highly dependent and medically compromised residents
    • Oral health assessments
    • Mouth Care Policy in accordance with NICE Guidelines and CQC recommendations

    What are the expected learning outcomes for you and your staff?

    On successful completion of this course delegates will be able to:

    • Identify basic dental anatomy and recognise abnormalities
    • Carry out mouth care assessments for residents in care homes
    • Create oral care plans for all residents
    • Outline the potential effects of poor oral health on individual's general health and well-being
    • Provide daily mouth care for all residents
    • Use newly learned oral hygiene techniques
    • Deliver denture care
    • Acknowledge coping strategies for residents with challenging behaviour towards mouth care
    • Provide daily mouth care for highly dependent and medically compromised residents including:
      • Dementia
      • Nil by mouth
      • Palliative care

    Meet Jane, our trainer for the day

     

     

     

     

    Jane Peterson RDH, BSc

    Jane has completed a Bachelor of Science degree in Oral Health Promotion, which highlighted to her the need for Oral Health Promotion in Care Homes and enabled Jane to reflect on oral health status and develop preventive strategies for care staff and the elderly in care homes. Jane carries out oral healthcare visits in a number of care homes and because of her experience she understands the challenges some residents pose with daily oral care. Jane currently works in General Practice 1 day a week, the rest of her time is dedicated to teaching and speaking at group meetings and seminars nationally to Dental and Healthcare Professionals.

    We have limited spaces available and we are expecting a high level of demand for this event so we recommend that you book your places today to avoid disappointment!

    So here’s that link again: https://hcsuk-oral-health.eventbrite.co.uk

    We look forward to sharing our knowledge with you on the day.

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