Mouth Care Training for Care Staff in Continuing Care

Transcription

1 Mouth Care Training for Care Staff in Continuing Care Train the Trainer Manual January, 2016 Edition

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3 Section 1 Administration Section 2 Mouth Care Why and How Section 3 Section 4 Skills and Strategies in Managing Care Responsive Behaviour Observation, Assessment, Care Planning and Referral Section 5 Teaching Resources

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5 Section 1 Administration

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7 Mouth Care for Residents in Continuing Care MANUAL FOR TRAINERS Section 1 Administration Table of Contents Acknowledgements Program Description, Course Outlines and Schedule Recommendations Check List for Trainers Course Administration and Evaluation Program Evaluation Summary Course Preparation Oral Health Framework Pre Facility (Unit) Assessment Determining Oral Health Training Needs for your Continuing Care Facility Quality Improvement Evaluation Oral Assessment Record for Continuing Care (RAI Section L1) Oral Assessment Record for Continuing Care Criteria Definitions Oral Assessment Record for Continuing Care Pre & Post Training Assessment Training Evaluation Pre-Training Quiz Post-Training Quiz Pre/Post Quiz Answer Key Assessment of Learning Impact Tool Evaluation of Mouth Care Education Certificate of Participation Samples Reporting Training Annual Reporting of Mouth Care Training Sessions January, 2016

8 Section 2 - Mouth Care Why and How Mouth Health and Healthy Aging Power Point Notes: Mouth Health and Healthy Aging - Target Audience: All Daily Mouth Care Plan Power Point Notes: Daily Mouth Care Plan - Target Audience: HCA Handouts Tooth Brushing Technique Steps Guidelines for Mouth Care Protocol with Mop-As-You-Go Mouth Care Planning with the RAI/Disablement Process Guidelines for Mouth Care and Denture Care Products Denture Care Power Point Notes: Denture Care - Target Audience: HCA Handouts Basic Mouth Care: Caring for those with dentures/false teeth/no teeth Section 3 - Skills and Strategies in Managing Care-Responsive Behaviour Managing Care-Responsive Behavior Power Point Notes: Managing Care-Responsive Behavior - Target Audience: All Handouts Mouth Care Level 1 poster/info sheet Mouth Care Level 2 poster/info sheet Mouth Care Level 3 poster/info sheet Mouth Care Level 4 poster/info sheet Resisting Mouth Care Problem Solving Grid Reducing Care Resistant Behavior in Oral Hygiene Chart from Jablonski Tips for Mouth Care Success Facilitator Resources: Resident Stories (from Alberta care facilities) Suggested Reading Reducing care-resistant behavior in oral hygiene. Special Care Dentist (2011,3 31) pp Jablonski, R.A. et al January, 2016

9 Section 4 - Observation, Assessment, Care Planning and Referral Observe for Changes Power Point Notes: Observe for Changes: The Healthy Mouth - Target Audience: All PDF Presentation: Mouth Care Decision Tree Document: Version 3 - Target Audience: RN/LPN Power Point Notes: Mouth Care Planning Using the RAI and Disablement Process and Mouth Care Decision Trees Audience: RN/LPN Section 5 - Teaching Resources What can you see? - laminated slides for classroom use Choking Risk Activity January, 2016

10 Mouth Care for Residents in Continuing Care Acknowledgements The Oral Health Action Plan provided the foundation for the collaborative work of the Provincial Oral Health Office, the Seniors Oral Health Working Group and the AHS Seniors Health Portfolio in development of the Mouth Care for Residents in Continuing Care resources. Contributing members of the Seniors Oral Health Working Group from 2011 to 2015 included: Cindi de Graaff, RDH Dr Marianne Howell, DDS Brenda Pullar, RDH Christine Keryluk, RDH Jenean Johnson, RDH Joanne Penteluk, RDH Kristin Griffiths, RDH Leanne Rodine, RDH Nina Kennaugh, RDH Sandy Jensen, RDH Team Lead, Provincial Oral Health Office Associate Dental Public Health Officer, Provincial Oral Health Office Content Specialist Calgary Zone Content Specialist Central Zone Content Specialist Central Zone Content Specialist North Zone Content Specialist South Zone Content Specialist Calgary Zone Content Specialist Edmonton Zone Content Specialist Calgary Zone The Provincial Oral Health Office would like to thank the following people and organizations for their support and important contributions to this resource: 1. Alberta Health Services Seniors Health Executive for their ongoing support and encouragement to develop a Mouth Care Training program for Alberta. Cheryl Knight, Executive Director of Seniors Health Kathryn Brand, Director of Practice Development Eleanor Risling, Director of RAI-MDS 2.0 Colin Zieber, Executive Director Seniors Health South Zone January,

11 2. Long Term Care Facilities and Staff for their collaboration in developing the Mouth Care Planning with the RAI MDS and the Mouth Care Decision Tree tools fundamental to the AHS Mouth Care for Residents in Continuing Care Training Program. Beverley Care Lake Midnapore Age Care Centre** Calgary Zone Capital Care Continuing Care; Best Practice Committee** Edmonton Zone Hythe Long Term Care Facility** North Zone River Ridge Masterpiece Care Center** South Zone Michele Stanley, Seniors Health Clinical Support Manger Central Zone Terri Woytkiw, Seniors Health Lead, Clinical Support North Zone **Special thanks to these facilities for volunteering to host mouth care training pilots at their sites. This helped to validate the mouth care tools and content of the program. Manual Approvers, Editors, Reviewers and Assemblers: Dr. Rafael Figueierdo, DDS Jennifer Painter Cynthia Huber, RDH Sylvia Baron, RDH Cindy Buzinski Provincial Dental Public Health Officer, Provincial Oral Health Office Provincial Oral Health Manager, Provincial Oral Health Office Team Lead, Provincial Oral Health Office Team Lead, Provincial Oral Health Office Administrative Assistant to Jennifer Painter, Provincial Oral Health Office This manual may be reproduced in whole or in part for non-commercial use provided appropriate credit is given to the Provincial Oral Health Office, Alberta Health Services. January,

12 Mouth Care for Residents in Continuing Care Program Description, Course Outlines and Schedule Recommendations Mouth care is important to overall health. The Chief Dental Health Officer of Canada states that Your mouth provides a window into the health of your body. You are not healthy if your mouth is not healthy. Many of the residents living in continuing care require some level of support in order to maintain good oral health. This series has been developed to provide non-oral health trainers with basic information and resources to train health care providers in the knowledge and skills needed to support residents of continuing care facilities to maintain their oral health wile in residential care. This manual contains resources and evaluation tools for successful training sessions. You are asked to submit the evaluation documentation to AHS from each session on an annual basis. See Course Administration and Evaluation section for more details. Pre and Post Assessment tools A. Pre facility assessment tool is a survey of the facility to provide the facilitators with a profile of the staff and residents to better plan and prepare for the training in the facility. B. Pre and Post training assessment tools Pre-quiz at the beginning training Post quiz for the end of the training sessions Education Session Evaluation tool at the end of each education session including classroom and resident demonstration Follow up questionnaire of administration and select staff at the 6 mouth post training to evaluate retention of training knowledge, perceived changes in practice, perceived changes in residents, etc. Mouth Care Training Sessions: The mouth care training program can be broken down into individual sessions or delivered in combination to make a half day of training. Where possible it is encouraged to have RN, LPN and HCA participate in training sessions together to build a team approach to mouth care. Mouth Care Session (30-45 min)*** (can be broken down into 15 min lessons) HCA RN/LPN if time constraints are present this session could be optional for RN/LPN The basics of mouth care are covered in this section: The importance of oral health to general health The framework of a good mouth care program in continuing care and the roles each person of the health care team plays. Introduction of the 4 levels of mouth care support based on the disablement process model and the residents ability to provide self-care indicated by ADL and CPS scores (this will be discussed further in the section on care resistant behaviors). January,

13 Review of practical skills: Two protocols for mouth care basic and modified based on the individuals swallowing/choking risk, introduces the different levels of support for mouth care. Starting with good brushing technique to remove plaque and debris and keep residents comfortable Reviewing the technique of Mop-as-You-Go Applying toothpaste following brushing Care of toothbrushes following brushing The practical skills of brushing are practiced on plaster cast models of teeth IPC of mouth care Peer brushing exercise - brushing one side of the lower arch with a moist toothbrush (no toothpaste) using the brushing techniques and paying attention to the resident s perspective of having another provide mouth care for them *** Mouth care products Denture Care (20 min) This section covers Reasons people like and avoid dentures Implant supported dentures Basic denture types Denture labelling Removing and inserting dentures Basic cleaning of dentures Denture products Managing Care Resistant Behavior Session (45min can be broken down into 15 min mini lessons) RN HCA This section elaborates on using the disablement process model in care planning for the appropriate level of support needed by residents to support them in maintaining their mouth care. The 4 level mouth care plan is based on the decline in CPS and ADL scores. Participants will be able to: Identify characteristics or behaviors common in delivering mouth care at each stage of the disablement Identify problem solving strategies and mouth care techniques to work with these behaviors to provide resident care As time permits, discuss current resident challenges and develop a strategy plan for next mouth care session (If these individuals have consents to participate in the resident demonstrations, this learning could be taken to the floor at some point in the training) Tools: Handouts on mouth care strategies and techniques Use of personalized in-room mouth care communication cards o assist staff implementing new practice o record and promote individualized care o inter-staff communication o build success for the resident and staff January,

14 Decision Trees Part I Observing for Oral Health Changes Session (90 min can be broken down into min mini lesson) HCA, LPN, RN This section is the introduction to the first level of the decision trees Possible Oral Health Triggers. It is geared for all staff (HCA, LPN and RN). Learning to recognizing observable oral health triggers early helps the resident receive earlier assessment and intervention, experiences less discomfort and improved quality of life. These skills will be valuable for RN and LPN to use on the initial assessment when the resident arrives at the facility to determine their oral health status. The HCA focus is to observe and report recent changes in the resident s oral health or oral behavior. Through the use of visuals aids, the learners will be able recognize: The appearance of healthy mouth Common visual triggers of oral health issues Other no visual triggers that may indicate oral health issues Learning activities include: What do you see? apply what they learn to real life photo scenarios. For HCA s an additional question is posed What would you report to the RN? Partner activity Participants will use a toothbrush and a pen light tools available when observing or assessing their residents to practice the skills of looking and observing for changes in the mouth. (A toothbrush and penlight will be supplied to each participant as part of their training package.)*** *** If a 3 hour training session is held that combines Mouth Care, Denture Care, Managing Resistive Behavior and Observing for Oral Health Changes. The peer brushing from Mouth Care and the partner activity from Observing for Oral Health Changes can be combined into one activity in the second half of the 3 hour session. Decision Trees Part II Oral Assessment: Mouth Care Decision Tree Session (40-90 min) RN and LPN This section develops further oral assessment skills, mouth care planning and follow up on oral health issues. Key areas of focus will include: Skills and knowledge to accurately record on the RAI section L1 a-e data elements How to use the Mouth Care Decision Tree Review Using the Mouth Care Planning with the RAI Tool Activities include o What do you see? apply what they learn to real life photo scenarios. o Application of tools to local resident January,

15 Resident Participation in Mouth Care Learning Activities (optional) The purpose of the program is to improve resident mouth care. Involving the residents and their family in the process can be an important part of the training. The resident can be involved in the staff s learning in two ways; the pre assessment and the resident demonstrations on mouth care and assessment for staff learning. Staff begin to apply their new skills right away in their working situations and pre and assessments prior to the training and a few months after the training help the facility to track the changes to patient care resulting from the training. Pre and post clinical assessment tools for tracking general oral health status changes pre and post training. Post Assessment would be conducted 3 months following the completion of the training period. Purpose is to determine if the training is making a difference in resident care in two areas. Have HCA skills improved in supporting residents with their daily mouth care? Is there less debris, is debris present easier to remove (indicating it is fresh) and are gums bleeding less with brushing changes in these observations can indicate that daily brushing practices have improved. Resident Demonstrations Sessions (on the unit) HCA, LPN and RN Resident demonstrations provide an opportunity for staff observe or put into practice the mouth care and patient management skills on their own residents to enhance their learning and develop practical real-time skills with the support of a facilitator or mentor. These sessions are provided on the unit in the days (and where possible weeks) following the in class training by the facilitator and involve 1-3 staff member along and take min depending on the learning experience. If a Dental Hygienist from AHS is to be involved in onsite hands on training program, a consent from the participating resident or their Alternate Decision Maker will be required to provide these services. A cover letter to the resident or the alternate decision maker with an indirect written consents process has been developed to achieve this consent process. January,

16 Checklist for Trainers Mouth Care for Residents in Continuing Care Post an agenda at the beginning of every session. Keep to the time limits for each session. Have each participant chose one challenging resident and develop an Action Plan to implement an oral health strategy or technique. Mouth care improves one resident at a time. If people are reluctant to participate in activities, gently encourage, but do NOT force their participation. You may be able to take this opportunity to discuss the fact that often residents share similar uncomfortable feelings when faced with their loss of independence. Encourage participants to examine their own experiences and to share these with the group. Monitor sharing to prevent individual monopoly. Keep sharing directed toward the subject. Reinforce verbally or non-verbally (nods of head, etc.) with every person. Do NOT add anything to the content of the program that is not provided in the manual. If a question arises that you cannot answer, inform the participants that you will take this back to the Zone Dental Hygienist for more information. We are here to assist you as your content experts. The program provides the trainers with Resident Stories that have been matched to communicate the learning objectives. As you journey through your training and oral health experiences you may come across your own resident stories you would like to share. The Provincial Oral Health Office asks that you consult with us before using them in your training to confirm they are applied in the most suitable area of content. January,