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| Oral Care Interventions in Critical Care: Frequency and Documentation |
Adapted from American Journal
of Critical Care |
March, 2003; Vol. 12, No. 2; pp. 113-118 |
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Authors: Mary Jo Grap, RN, PhD, ACNP, Cindy L. Munro, RN, PhD, ANP, Brooke Ashtiani, and Sandra Bryant.
From Virginia Commonwealth University School of Nursing, Richmond, Virginia.
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INTRODUCTION: |
- "The purposes of this project were to describe oral care interventions reported by nurses and to determine how often these interventions are documented in medical records."
- Although patients' oral care is a key component of nursing care, it is often considered primarily an intervention for patients' comfort. This may reduce its priority and thus its frequency.
- "Previous research indicates that vigorous oral hygiene is necessary to reduce oral colonization. Toothbrushing is effective in reducing the number of oral microorganisms, but toothbrushing, even though it is an independent nursing action, is not routinely performed in critically ill patients..Oral hygiene measures are generally directed toward patients' comfort rather than removal of microbes."
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RESEARCH METHODS
Setting and Sample |
- Data collected in medical respiratory, surgical trauma, and neuroscience ICUs at a large southeastern academic medical center. Subjects: 170 ICU nursing care providers and critically ill ICU patients. Data for critically ill was obtained from medical records.
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Oral Care Survey |
- Survey distributed to staff asked for: how often the respondent generally performed oral care for nonintubated patients and for intubated patients, plus demographic data. Respondents estimated how frequently oral care was performed and what tools/solutions were used, and rated the priority of oral care.
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Frequency of Documented Interventions |
- At 5 random times during a 1-month period, oral care interventions were recorded from the ICU flow sheet of the medical record for the previous 24 hours for all ICU patients.
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RESULTS
Oral Care Survey |
- 75% of respondents reported providing oral care 2 or 3 times/day for nonintubated patients. 72% reported providing care 5 times/day or more for intubated patients.
- Reported use of toothpaste and toothbrush was significantly greater in nonintubated patients. Use of a foam swab was significantly greater in intubated patients. Nurses mean rating (1=lowest/100=highest) of oral care priority was 53.9.
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Medical Record Documentation |
- Documentation of oral care in the medical record was at marked variance from nurses' self-reports. Documentation of oral care on flow sheets for the 170 ICU patients during the preceding 24 hours was found 205 times (mean 1.2 times per patient).
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DISCUSSION: |
- Reasons ICU nurses may be hesitant to provide oral care to intubated patients: endotracheal tubes may limit access, fear of displacing/dislodging tube, perception that oral care contributes less to health/well-being (or has lower priority) than other interventions, patient acuity, and staffing levels.
- "Foam swabs, which are commonly used to provide mouth care to patients unable to do their own care, are effective for stimulation of the oral mucosal tissue but are ineffective in plaque removal.."
- "Pearson reported that in healthy volunteers foam swabs were less effective at plaque removal than was toothbrushing and noted that the efficacy of foam swabs depended on the user's technique."
- "Toothbrushes are more effective in plaque removal and gingival stimulation than are foam swabs, and toothbrushes are generally regarded as the best tool for oral care in healthy populations. However, Iacono et al noted that the effectiveness of the toothbrush depends on use of the device 'in a proper fashion for a sufficient duration of time and with adequate frequency.'"
- "Our survey results indicate that toothbrushes were not uniformly used in nonintubated patients and were less commonly used in intubated patients. This finding is consistent with previous findings that toothbrushes are less commonly used than foam swabs in providing mouth care to hospitalized patients."
- "Nurses report frequent oral care interventions, but few are documented. Education and focus on good oral care strategies are required.."
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The full text of this article may be viewed at ajcconline.org >March 2003. For reprints, call 800-809-2273 ext 532 or e-mail reprints@aacn.org. |
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