Critically ill people, who may be unconscious or sedated while they are treated in intensive care units, are often provided with breathing assistance devices. The use of these medical ventilators may result in some complications, first in such as ventilator-associated pneumonia (VAP), which is a potentially severe state for all categories of patients. The outcomes of VAP or other infections may be fatal for critically ill people. Various types of oral hygiene care may significantly reduce these risks; however, their usage in practice lacks consistency and uniformity. Hence, implementing congruous protocols and feedback systems is vital for making the positive effects of oral care more evident and systematic.
In the absence of oral care protocols and feedback systems, the majority of nurses were not providing oral care according to the latest evidence-based practice. Recent research papers also demonstrate that there is a lack of consistency in oral care methods and frequency between intensive care units in different hospitals and even within the same hospital (Ganz et al., 2013). It has also been shown that oral care has a significant impact on the medical outcomes of patients treated in intensive care units. If clear oral care guidelines are not present, and the knowledge of the latest evidence-based practices is not promoted, the critically ill people are more vulnerable to possible complications, including fatal outcome.
Implementing oral care protocol at the nation-wide level is proved to have strong positive effects on patient care, including reduced VAP cases as well as other complications. The side effects may involve a higher level of bedside staff satisfaction and increased cost efficiency as far as oral care medical supplies are concerned. Thus, a set of subsequent research papers (Ganz et al., 2013) shows considerable positive changes in the oral care practices for ventilated patients after a notable national effort to increase evidence‐based oral care practices. According to the researchers, “there was a statistically significant increase in the use of EBPs as shown by the EBP score and in the perceived priority level of oral care” (Ganz et al., 2013, p.355). A nation-wide policy may be implemented by the government or by the national or regional medical associations.
On a local level, an introduction of oral care protocols, including oral examination and feedback systems, also shows very promising results. For example, the implementation of the Bedside Oral Exam and the Barrow Oral Care Protocol together with the oral assessments was associated with a 50% drop in VAP cases, 65% reduction in oral care supply costs, improved staff satisfaction as well as declared compliance with the oral hygiene (Prendergast et al., 2013). However, the non-evidence-based practices, such as the use of certain drugs and medical supplies, were ceased.
The plan of changes in current practices may include standardization and setting a higher priority level to the oral care procedures. First, teeth brushing and oral assessment must become regular and compulsory since the positive effects of these procedures are well-documented (Ganz et al., 2013, p.355). Second, non–evidence‐based practices, such as the use of gauze pads, tongue depressors, lemon water, and sodium bicarbonate, should be minimized. As a positive effect of their usage is not proved, the unnecessary costs should be eliminated. The expected favorable effects of the proposed changes include the reduction in ventilator-associated complications, cost savings, and improved patient satisfaction levels.
References
Ganz, F., Ofra, R., Khalaila, R., Levy, H., Arad, D., Kolpak, O.,… Benbenishty, J. (2013). Translation of oral care practice guidelines into clinical practice by intensive care unit nurses. Journal of Nursing Scholarship, 45(4), 355–362.
Prendergast, V., Kleiman, C., & King, M. (2013). The bedside oral exam and the barrow oral care protocol: Translating evidence-based oral care into practice. Intensive and Critical Care Nursing, 29(5), 282–290.