Improving Oral Care Delivery and Staff Confidence on Geriatric Medicine Wards: A Quality Improvement Project

Introduction

Poor oral health is associated with increased rates of hospital-acquired infections and prolonged hospital stays (1), with aspiration a major contributor of preventable morbidity and mortality (2). Recent evidence suggests that 60-80% of older inpatients have unmet oral care needs, whilst only 38% of nursing staff have had formal oral care training. An audit conducted by the SALT team at the University Hospital of Wales identified widespread poor oral hygiene and a need to upskill staff in this area. This QIP aimed to improve patient oral care, and staff confidence in oral care through brief break-time teaching.

Methods

A Plan–Do–Study–Act (PDSA) cycle was completed on two geriatric medicine wards. Patients (n=44) were assessed using quantitative and qualitative questionnaire items and an objective oral health assessment tool. Four oral care teaching sessions were delivered to ward staff (n=27). Staff confidence was measured using pre- and post-session questionnaires. Educational handouts were provided, and patient oral care was re-assessed in subsequent weeks.

Results

Most patients had not routinely be asked about oral-care needs, despite reliance upon staff for support, with 84% of patients reporting unchanged or worsen oral care since admission. Following teaching, 93% of staff reported increased confidence in providing oral care, including assessment, tooth brushing, and management of patients with challenging behaviour. Awareness of the link between oral care and pneumonia increased from 80% to 100%. All attendees supported ward-based posters, and 96% reported a need for further training.

Conclusion

This QIP identified low confidence among healthcare professionals in delivering oral care despite its recognised clinical importance. Targeted teaching improved staff confidence and awareness, with potential to enhance patient oral hygiene and reduce risk of serious illness. A second PDSA cycle will introduce ward-based prompts and review available mouth-care resources to support sustained improvement.