title: The Bedside Oral Exam and the Barrow Oral Care Protocol: translating evidence-based oral care into practice.
abstract: OBJECTIVE
  To introduce the Bedside Oral Exam (BOE) and the Barrow Oral Care Protocol (BOCP) to guide oral care for intensive care unit patients. Secondary aim: To explore quality improvement data for incidence of ventilator associated pneumonia (VAP), cost effectiveness of oral hygiene supplies and staff response to change in practice.
  
  
  METHODS
  Descriptive case design for implementation and evaluation of oral assessments and oral hygiene. Incidence of VAP and the cost of oral care supplies before and after implementation was compared. Staff responses were elicited both pre- and post-implementation.
  
  
  RESULTS
  Incidence of VAP fell significantly from 4.21 to 2.1 per 1000 ventilator days (p =.04). A cost savings of 65% was noted on a monthly basis for oral hygiene supplies. Staff reported increased satisfaction in providing oral hygiene with a combination of oral care products.
  
  
  CONCLUSIONS
  A significant reduction in VAP was noted using the BOCP. The BOE guided individualised oral care with contemporary supplies, including a tongue scraper, electric toothbrush, non-foaming toothpaste and oral moisturisers. Cost-effective, comprehensive oral care appears to be effective in reducing VAP. Further studies are needed to assess impact of oral hygiene on oral health and patient comfort.
authors.affiliation: Division of Advanced Practice Nursing, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA. Neuropub@dignityhealth.org
authors.forename: Virginia
authors.initials: V
authors.lastname: Prendergast
authors.forename: Cindy
authors.initials: C
authors.lastname: Kleiman
authors.forename: Mary
authors.initials: M
authors.lastname: King
mesh_terms: D002985:Clinical Protocols; D003362:Cost-Benefit Analysis; D064648:Critical Care Nursing / Q000592:standards; D055318:Evidence-Based Nursing; D006801:Humans; D009730:Nursing Assessment; D009909:Oral Health; D009910:Oral Hygiene / Q000191:economics / Q000451:nursing*; D053717:Pneumonia, Ventilator-Associated / Q000451:nursing / Q000517:prevention & control*; D058996:Quality Improvement
keywords: Evidence-based care; Nursing care; Oral hygiene; Tooth brushing; VAP