When I was asked to undertake mouthcare at the start of my nurse training back in 1981 I was taught to put on a pair of gloves, wrap a piece of gauze soaked in bicarbonate solution around my index finger, put it in my patient’s mouth and hope they did not bite.
There was no evidence base for this but we did it routinely for anyone who was nil by mouth or receiving restricted fluids even though we didn’t get great results – and sometimes we were bitten. Then pink sponges on sticks were introduced and quickly replaced our fingers as mouthcare tools.
“This practice is a marker of how mouthcare is not given sufficient consideration”
Unfortunately, pink sponges have been identified as a choking hazard. Over six years ago they were the subject of a Medicines and Healthcare products Regulatory Agency safety warning. They have been banned in Wales and many individual organisations elsewhere in the UK have taken similar action.
However, some nurses continue to use this potentially dangerous device because they are not aware of the problems or do not have access to alternatives. This practice is a marker of how mouthcare is not given sufficient consideration and practice is often governed by ritual and routine.
Mouthcare is often described as ‘basic’ care and on the surface it appears to be a straightforward task that can be easily delegated to unregistered staff. However, there is evidence that patients’ oral health deteriorates while they are in hospital and this affects not only their dignity and self-esteem but also their nutritional intake. Poor oral hygiene is also associated with hospital-acquired pneumonia.
We all accept that mouth care is a fundamental part of nurses’ work but in 2015 Health Education England launched a Mouth Care Matters campaign because of growing concerns about poor standards of oral care.
Last year, we published the outcomes of a project by Mouth Care Matters that highlighted barriers including a lack of training, mouthcare assessment tools, policies and equipment.
Healthcare organisations have a responsibility to supply nurses with equipment to carry out safe and effective mouthcare. A soft toothbrush is more effective than a pink sponge and triple-headed toothbrushes are helpful for patients who cannot tolerate oral care for sustained periods.
We have just published a guide to mouth care equipment and there is a surprising range of products available. This article provides a good starting point for conversations about how to meet patients’ needs.
“Maintaining patients’ oral hygiene is an essential nursing duty”
We have also published a step-by-step practical procedure guide to mouth care to help update nurses, healthcare assistants and nursing associates on current practice.
Maintaining patients’ oral hygiene is an essential nursing duty. It is not basic or simple.
If we choose to delegate the task we need to ensure that staff understand why they are doing it, have appropriate training and the tools to maintain patient safety and dignity.
Mouth care is not a ‘nice’ optional extra and we need to remember that failure to deliver it can have serious consequences for patients.