Abstract
A growing body of research indicates that many people, especially older patients, experience increased oral health risks during their hospital stay. Oral healthcare is also known to be one of the most missed aspects of fundamental care reported by patients. Importantly, failure to provide patients with basic daily oral healthcare leads to adverse health consequences such as hospital acquired pneumonias, longer hospital stays, increased health costs, concerns related to the safety and quality of care, and poor patient experience.
SA Dental, Caring Futures Institute of Flinders University and the Southern Adelaide Local Health Network (SALHN) formed a collaboration from July 2020 to April 2022. This partnership was a response to calls from a group of multidisciplinary lead clinicians from the SALHN Division of Rehabilitation, Aged Care and Palliative Care (RAP) who were interested in improving the provision of daily oral healthcare as a risk mitigation strategy against hospital acquired pneumonias in Geriatric Evaluation and Management (GEM) Unit patients.
Called REDUCE (tRanslating knowlEDge for fUndamental CarE) missed oral healthcare: it takes a team, the project’s key aims were to identify the gaps between current oral healthcare practice and recommended evidence-based practice and to develop tailored multidisciplinary team (MDT) strategies to improve the adherence to evidence-based oral healthcare.
To do this, we combined the SAHLN Safety and Quality framework with a Knowledge Translation (KT) approach, named the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) (Harvey & Kitson 2015). Instrumental to this approach was the use of active multilevel facilitation, occurring at both the GEM Unit level and the RAP Divisional level, using local facilitators from the Whittaker GEM Unit and expert facilitators from the Caring Futures Institute of Flinders University and SA Dental.
Facilitation was used to purposefully guide the development of multidisciplinary team (MDT) implementation strategies aimed at improving the delivery of evidence-based oral healthcare in GEM Units
The project took place during the extraordinary and unpredictable circumstances of the COVID 19 pandemic. While staff were supportive of the need for evidence-based oral healthcare, they were often unable to participate in meaningful multidisciplinary quality improvement. This had a profound impact on project activities and hindered the role and process of facilitation, the actioning of project implementation strategies and compromised staff’s efforts aimed at improving oral healthcare.
This serves as a reminder that improving healthcare practice takes active facilitation (role and process) involving a three-stage process of implementing, embedding, and sustaining change. This supports the view that sustained change largely follows deliberate alterations in clinical governance structures and action, rather than it being dependent on changes in the beliefs and/or intentions of individual staff members.
These findings led to the development of a suite of multilevel MDT implementation strategies designed to improve and sustain adherence to evidence-based oral healthcare. A multilevel MDT facilitation work plan has been developed to:
1) systematise oral healthcare as a recognised aspect of comprehensive care
2) formalise oral healthcare as an organisational mitigation strategy for the prevention of hospital acquired pneumonias