Authors (including presenting author) :
Chan YM(1), Hai SFC(1), CHAN TMJ(1)
Affiliation :
(1) Palliative Care Unit, Our Lady of Maryknoll Hospital
Introduction :
Oral problems are common among patient with advanced cancer. Although mouth care is considered as one of the basic nursing care, it is frequently neglected and causes a negative impact on patient‘s quality of life both physically and emotionally (Kinely & Brennan, 2004). Good oral health is the absence of pain and disease with the ability to eat, drink and communicate which is important for quality of life.
Common oral problems include dry mouth, oral bleeding, oral pain, infection, bad breath and change of taste. If problems are not treated properly, it will not only lower patient’s self-esteem, ability to communicate, socialise, enjoy food and drinks, but also induce discomfort and pain. Sarah Hurley stated “Every patient has a mouth, therefore each and every care pathway must reflect the enduring need for oral care, this begins by putting the mouth in the body.
Objectives :
the aim of this quality improvement project was to increase the awareness of the importance in maintaining patient‘s oral hygiene among nurses and health care assistants, identify the knowledge gap and to enhance skill of ward staff in proper mouth care, also to educate family carer on the provision of quality mouth care.
Methodology :
This project was divided into two parts. First, we conducted a baseline audit on mouth care provision to patients by nurses and health care assistants, so as to review the usual practice, including their attitude and knowledge gap. A mouth care toolkit which includes proper procedure and commonly used equipment was designed as a reference. After that, return demonstration on quality mouth care was arranged to enhance staff competency. Lastly, questionnaire survey about awareness and knowledge was conducted among ward staff before and after training in order to evaluate the outcome of the project.
During the study period, 28 patients were recruited because they met the following inclusion criteria: i) admit as a palliative cancer patient, ii) need assistance for mouth care, and iii) able to give a verbal consent for assisted mouth care.Pre- and post-symptom assessment was carried out with patients to explore the improvement in oral hygiene.
Result & Outcome :
Majority of patients (93%) reported dry mouth, in which 22% of them even rated 3-4 on VRS on Day 1. Besides, oral cleanliness, oral discomfort, and bad breath were experienced by 79%, 64% and 43% of the patients respectively.On Day 7, although 75% of the patients reported that they still experienced dry mouth, the score were significantly decreased to 1-2. Furthermore, the number of patients who reported
to have symptoms decreased in all categories, especially in oral cleanliness and bad breath, with a decrease by 18% and 21% respectively.
From the two questions concerning the outcome of education and quality of life, 92% of them stated that they had received education of mouth care and had benefited from it. Meanwhile, 89% of them were satisfied with the mouth care provided by ward staff in improving life quality.
