POLICYPATIENT CAREORAL CARE TECHNIQUES	ISSUE DATE:
		REVISION DATE:			Page 1 of 2
JCAHO STANDARDS/DHS REGULATION:		REVIEW DATE[S]:

PURPOSE

It is the policy of XXX Hospital that oral care contributes to the improved health and comfort of the hospitalized patient.  Oral care decreases the microorganisms in the oral cavity, is preventive care for tracheobronchitis and ventilator acquired pneumonia, improves the taste of food and the appetite, and stimulates circulation in the oral cavity.  Additionally, oral care promotes comfort and improves appearance and self-esteem. The following individuals at all XXX Hospital locations are providers of oral care as part of the plan of care:

PERSONS AFFECTED

• Registered Nurse (RN)                                                           l    Occupational Therapy (OTR/L COTA/L)
• Licensed Vocational Nurse (LVN)                                         l    Speech Language Pathology (SLP)
• Certified Nursing Assistant (CNA)                                        l    Respiratory Care Practitioner (RCP)

POLICY STATEMENT AND/OR PROCEDURE

1. The oral cavity is assessed initially and at least once a shift by the Registered Nurse.  Specifics of oral hygiene can be delegated to other levels of nursing, including LVNs and CNAs, depending on the skill level required.
2. For patients independent in oral care, provide toothbrush, toothpaste and water for rinsing.  Alternatively, use a moistened toothette for patient to swab inner cheeks, lips, tongue and all surfaces of oral cavity.  Nursing, RCP, Occupational therapy and SLP may provide assistance as required.
3. Intubated patients will be assessed to determine the need for removal of oropharyngeal secretions every 2 hours by the RCP as well as prior to repositioning the tube or deflation of the cuff.
4. Depending on the skill level required, the RCP, OTR/L, COTA/L and SLP may assess and provide oral care in addition to the oral care provided by nursing.
5. Unconscious or intubated patients are provided oral care three times a day and PRN by the nursing staff. In providing/assisting with oral care, the nursing staff will:

• Determine the patient’s ability to understand and follow instructions
• Determine for presence of dentures, loose teeth, and mouth lesions
• Washes hands, dons gloves and explains the procedure to the patient
• Lowers the side rail, places the patient’s head to the side with the head of the bed at least 45 degrees, or places the patient in the side lying position
• Places towel on patient’s chest, then the licensed nurse can provide deep suction, as needed, in intubated patients to remove oropharyngeal secretions that can migrate down the tube and settle on top of the cuff
• Brushes teeth using suction toothbrush and small amounts of water and alcohol free oral rinse.  Teeth should be brushed for approximately one to two minutes.  Exert gentle pressure while moving in short horizontal or circular strokes. (For more specific details, see policy – Activities of Daily Living)
• Gently brushes the surface of the tongue
• Uses suction swab to clean the teeth, tongue and all surfaces of oral cavity if brushing causes discomfort or bleeding.  Place swab perpendicular to gum line, applying gentle mechanical action for one to two minutes.  Turn swab in clockwise rotation to remove mucous and debris.
• Applies mouth moisturizer inside mouth.
• Applies lip balm
• Discards gloves and soiled materials.
• Washes hands after providing oral care
• Documents oral care as completed on appropriate form(s)

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Tags: hospital oral care, oral care protocol, sample oral care protocol