1. Rita Ann Classe, RDH, BS HCPI 557: Contemporary Healthcare Issues Texas A&M Health Science Center’s Baylor College of Dentistry

2. Introduction: Who Does the In-Service Program Target?  Residents at the San Rafael Nursing and Rehabilitation Center in Corpus Christi, TX  Post-acute, rehabilitation, and long term healthcare services provided  Approximately 168 certified beds

3. Introduction: Target Population  85% female, 15% male  60% Hispanic, 30% white, 10% other  Medicare, Medicaid, & private insurances accepted  Primarily geriatric patients but rehabilitation services available to patients of any age

4. Introduction: Why Dental Care?  Dental care is available but limited  Visiting dentist only comes 1x/month  Residents receive limited assistance with their daily dental hygiene routine

5. Goal The dental care in-service program aims to increase the quality of life and general well-being of patients, as in accordance with the facility’s mission statement, by educating nursing staff to provide assistance with daily oral hygiene routines, increasing accessibility to dental care, and ultimately improving oral health status.

6. Objectives 1. Nursing staff will recognize the importance of oral health and a good oral hygiene homecare routine after an initial training session with 90% accuracy. 2. Nursing staff will perform routine dental hygiene homecare on patients requiring assistance in accordance with the recommendations of the dentist, dental hygienist, or occupational therapist. 3. The dental hygienist will assess the oral health status on given patients according to the Kayser- Jones Oral Health Assessment tool. 4. The nursing staff, occupational therapists, dentist, and dental hygienist will adopt the dental care in- service program for patients in a manner that is consistent with the mission statement of the facility.

7. Key Players  Dentist- Weekly visits for treatment and exams  Dental hygienist- Coordinate staff training, conduct staff and patient assessments, and assist patients on daily basis  Nursing staff- Continual educational training and evaluation on assistance with patient homecare  Occupational therapists- Teach and assist nursing staff and the dental hygienist on patients requiring special adaptation to their homecare routine

8. Training  Initial training upon implementing the in- service program  Initial training for new hires  Monthly meetings

9. Initial Training  Educational session for nursing staff led by the dental hygienist  Occupational therapist will discuss and demonstrate special adaptation techniques  Training is the same for initial implementation and new hires  Nursing staff must make at least a 90% on quiz before assisting with oral care

10. Initial Training  This video will be used to introduce the importance of dental hygiene to the nursing staff: Oral Care For Older Adults - YouTube

11. Training Topics  Why good oral health is important  Common oral health problems for older adults  Common problems caregivers encounter  Strategies and techniques for assisting patients with their oral care  Oral health assessments and screening process  When to notify the dentist and/or dental hygienist

12. Monthly Meetings  Dental hygienist discusses patient oral health status and assessment findings with nursing staff  Oral homecare techniques and available aids reviewed  Dental hygienist and occupational therapist available to nursing staff for questions and demonstrations

13. Assessments: Dentist  Periodic and emergency exams  Weekly visits for exam and treatment

14. Assessments: Dental Hygienist  Baseline assessment on all patients to determine the type and extent of oral homecare assistance needed  Monthly follow up assessments to monitor the oral health status of each patient  Monthly assessment of nursing staff oral homecare assistance technique

15. Assessment Forms: Baseline

16. Assessment Forms: Monthly

17. Nursing Staff Assessments  The dental hygienist will assess the nursing staff’s performance by observing the nursing staff as they assist patients  The monthly oral health status of patients will also be a measurement used to assess how well the nursing staff is performing oral care procedures  The monthly meetings will also be used as a time for the dental hygienist and occupational therapist to observe nursing staff

18. Role of the Occupational Therapist  Mental and physical disabilities may require special oral hygiene adaptation techniques  Train nursing staff and dental hygienist and work with patients

19. Although the goal is to ensure that patients have optimal oral care, it is important to recognize and respect their independence! Not all patients will require assistance. This will be determined at their baseline assessment once the program is implemented.

20. Conclusion  The dental care in-service program is an education and training program that requires collaboration of the nursing staff, dentist, dental hygienist, and occupational therapist to provide increased access to dental care and oral health assessments.  Through these efforts the dental care in- service program aims to not only improve oral health, but also improve the quality of life and general well being of the patients at the San Rafael Nursing and Rehabilitation Center.

21. The End Result