Joint Commission urges enforcement of oral care policies

Accreditation Insider, January 31, 2017

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Joint Commission urges enforcement of oral care policies
The Joint Commission is placing increased emphasis on the importance of oral care. In a recent blog post, Trina Crow, RN, MJ, associate project director at The Joint Commission, wrote that the long-term care facilities need to pursue oral care policies more intently. Along with tooth and gum disease, poor oral care is linked to pneumonia and endocarditis (an infection of the heart's inner lining).
“Performing oral care can be a very emotional event for some long-term care residents and the anxiety of residents in turn affects staff who are trying to assist them with their oral hygiene, it turns into a time consuming activity,” she wrote. “The statistics on this are alarming, according to a study published in the Journal of American Geriatrics Society, on any given day, 84%-100% of residents don’t receive any oral care. Furthermore, only 27% of the long-term care organizations in the study had oral care supplies and the average tooth brushing duration was only 60 seconds. Many care providers didn’t even change their gloves between helping the resident use the restroom and brush teeth.”
Although The Joint Commission doesn’t cite hospitals for oral care deficiencies, the organization considers it an essential part of patient care. Neither The Joint Commission nor CMS requires oral care policies for hospitals and critical access hospitals.
Dian L. Baker, PhD, APRN-BC, PNP, professor in the School of Nursing at California State University, Sacramento and Barbara Quinn, MSN, RN, ACNS-BC, clinical nurse specialist with Integrated Quality Services at Sutter Medical Center, Sacramento, co-authored one of the few studies and articles on oral care programs and pneumonia prevention in acute care settings. Their work showed that by putting an oral care program in place, hospitals can prevent 40%-60% of non-ventilator hospital-acquired pneumonia (NV-HAP). NV-HAP accounts for 62% of all hospital acquired pneumonia, and each prevented case saves $40,000 on average.
“This is an emerging prevention strategy for hospital-acquired infections that people haven’t really talked much about,” Quinn says. “I think it’s a wonderful step forward. I think it’s really the right direction for hospitals, and [we shouldn’t] wait for someone to tell them they have to measure something. Rather, being proactive in exploring and discovering hidden harm like this and putting something in place preventing it. And not waiting for someone like CMS to put out another measure that has to be reported publicly.”
“I certainly think most patients aren’t aware of it,” adds Baker. “So kind of our standard line is, ‘If you know anybody who’s going into the hospital, make sure they start brushing their teeth before they go in and make sure they brush their teeth four times a day.’ Once patients generally know the reason, that it’s important to prevent pneumonia and improve their health, they get motivated to take care of their oral care while in the hospital, too.”
For more on oral care, view our upcoming article in Patient Safety Monitor Journal.

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