The importance of supporting service users with their oral hygiene

in Old Colwyn, Joanne Lees, assistant coroner for North Wales East and Central, called for two updates in the next 12 months on how the improvements were being implemented and monitored by Conwy County Borough Council. Alfred Pilbeam, 79, who was registered blind, died at Glan Clwyd Hospital on February 25, 2018, four days after being admitted after Kath Longmire, manager of the care home, became concerned about his deteriorating condition. She called GP Dr Dylan Parry, who told the inquest in Ruthin that Mr Pilbeam had a suspected urinary tract infection. The pensioner had a history of heart problems and swallowing difficulties and was on a “soft diet”, with thickener in fluids. Dr Parry said he was dehydrated and had a white coating on his tongue and inside his cheeks. “I was struck by how unusual it looked and I was not 100% sure what it was,” he said. “I thought it might have been thrush or the residue of medication.” Mrs Lees asked him: “Were you not concerned with the presentation and whether it could have related to his care at Wynne Crest?” Dr Parry replied: “No. I was not sure what was causing it.” Mrs Lees: “Did you have any concern about his oral hygiene?” Dr Parry: “Yes. It struck me how abnormal the appearance was.” A safeguarding investigation was carried out after Mr Pilbeam’s death but Mrs Sian Wyn Jones of Conwy County Borough Council, said that while improvements to record-keeping were recommended it was concluded that there had been no neglect. Mrs Longmire told the inquest that more rigorous oral health checks were now carried out at the home. Recording a conclusion of natural causes, Mrs Lees commented: “I do find that the infection in his mouth was present on the 21st, the day of his admission to Glan Clwyd Hospital, but I cannot say how long it had been there. “It is clear there was poor oral hygiene, but I cannot say whether it was because x or y was not done. Poor oral hygiene can occur naturally or unnaturally.” This case should be seen as a wake-up call to many providers and care staff. Oral hygiene is not only an issue of safety but also of services user’s quality of life. Some staff find supporting service users with their oral hygiene to be challenging. Research has found the main obstacles to care staff carrying out mouth care with Service Use are as follows:

1. This aspect of care is considered by some as distasteful.

2. With Service Users who retain some of their teeth, care staff can show a reluctance to carrying out care inside the mouth. This is not such an issue with denture care.

3. Confusion over consent issues, fear of personal harm from resistant Service Users or a lack of dementia-specific care skills can discourage care staff from carrying out oral care.

4. Care staff (and managers) may not give oral care the priority that other care tasks receive. They may also be influenced by other factors such as workplace pressures.

Bettal Quality Management System In the Bettal quality management system we have recognised the importance of oral hygiene and developed a policy for it. The policy includes:

1. Principals of good oral care.

2. Oral assessment.

3. Oral care planning.

4. Monitoring of a service users oral health.

5. Staff training. Readers can get more information on the Bettal Oral Assessment Policy and the Quality Management System by looking at our Sample Documents or contacting us.

Summary The importance of service user’s oral hygiene is highlighted by the tragic death of a resident in North Wales. While in this case it could no be determined whether or not poor oral hygiene which can occur naturally or unnaturally was a contributory cause of death. Never the less it does draw our attention to the importance of oral hygiene to a person’s safety and quality of life, in an area of care that staff find most challenging. Albert Cook Albert Cook BA, MA & Fellow Charted Quality Institute Managing Director Bettal Quality Consultancy