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Meta-analysis of dysphagia

Updating our oral-care protocol

The Centers for Disease Control and Prevention’s 2003 Guidelines for the Prevention of HAP state that all patients should receive comprehensive oral care. Gap analysis showed our hospital had an oral-care protocol only for ventilated ICU patients.

To remedy this, we updated the protocol to cover all patients. It now specifies what supplies to use, what procedures to follow, and how frequently to perform oral care. Although we couldn’t find research on optimal frequency of oral care for med-surg patients, we determined it should be done four times daily, based on how quickly oral bacteria replicate (five times per 24 hours). The new protocol was put in easy-to-read table format, enlarged, and posted in supply rooms for easy access. (See Oral-care protocol.)

Documenting oral care

As with any other patient-care process, oral care should be documented. But our documentation system lacked a place to record the type and frequency of oral care provided. So we enlisted staff to redesign the documentation of basic nursing care in the medical record. The redesign was piloted and refined repeatedly until staff were satisfied.

Documenting oral care also was essential for monitoring our quality-improvement project and determining the impact of oral care on NV-HAP rates. To reinforce the importance of oral care, we conducted unit audits to monitor oral-care delivery, related issues, and barriers to providing adequate oral care on HAPPI units.