title: Implementing oral care practices and policy into long-term care: the Brushing up on Mouth Care project.
abstract: BACKGROUND
  Optimal mouth care is integral to the health and quality of life of dependent older adults.Yet, a persistent lack of adequate oral care in long-term care (LTC) facilities exacerbates the burden of disease experienced by residents. The reasons for this are complex and create enormous challenges for care providers, clinicians, and administrators dedicated to comprehensive high quality care.
  
  
  OBJECTIVE
  The aim of this study was to develop, implement, and evaluate a comprehensive program for daily mouth care for LTC.
  
  
  METHODS
  A case study design using a participatory and qualitative approach examined how individual, organizational (workplace practices and culture), and system factors (standards and policy) influenced the development and implementation of a comprehensive program to improve the delivery of daily oral care in LTC.
  
  
  METHODS
  The research was undertaken in 3 LTC residences administered under the same health authority and included personal care providers, nurse managers, and directors of care.
  
  
  METHODS
  A comprehensive program for care providers including, education, resources, and organizational guidelines, to improve the delivery of daily mouth care to LTC residents was created, rolled out, and refined over a 12-month period.
  
  
  METHODS
  Data was collected through diary studies, targeted interviews, field notes, oral care activities records, site team meetings, and direct feedback from members of the care team.
  
  
  RESULTS
  The oral care intervention resulted in a heightened awareness, support and greater efficiency amongst care team. The presence of a "champion" was a key feature for sustaining processes. Management had a clear role to play to ensure support and accountability for the intervention.
  
  
  CONCLUSIONS
  Optimizing oral care in long-term care can be achieved through an integrated approach that includes education, provision of resources, an oral care champion, support from managers and administrators, and appropriate organizational policy.
authors.affiliation: Faculty of Dentistry, Dalhousie University, Halifax, Canada; Faculty of Medicine, Dalhousie University, Halifax, Canada; Atlantic Health Promotion Research Centre, Dalhousie University, Halifax, Canada. Electronic address: mary.mcnally@dal.ca.
authors.forename: Mary
authors.initials: M
authors.lastname: McNally
authors.affiliation: Faculty of Nursing, Dalhousie University, Halifax, Canada.
authors.forename: Ruth
authors.initials: R
authors.lastname: Martin-Misener
authors.affiliation: Atlantic Health Promotion Research Centre, Dalhousie University, Halifax, Canada.
authors.forename: Karen
authors.initials: K
authors.lastname: McNeil
authors.affiliation: Faculty of Dentistry, Dalhousie University, Halifax, Canada.
authors.forename: Martha
authors.initials: M
authors.lastname: Brillant
authors.affiliation: Faculty of Medicine, Dalhousie University, Halifax, Canada.
authors.forename: Paige
authors.initials: P
authors.lastname: Moorhouse
authors.affiliation: Centre for Clinical Research, Capital District Health Authority, Halifax, Canada.
authors.forename: Sandra
authors.initials: S
authors.lastname: Crowell
authors.affiliation: Faculty of Dentistry, Dalhousie University, Halifax, Canada; Faculty of Medicine, Dalhousie University, Halifax, Canada.
authors.forename: Debora
authors.initials: D
authors.lastname: Matthews
authors.affiliation: School of Dental Hygiene, Dalhousie University, Halifax, Canada.
authors.forename: Joanne
authors.initials: J
authors.lastname: Clovis
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016321:Dental Care for Aged / Q000458:organization & administration*; D005260:Female; D006266:Health Education / Q000458:organization & administration; D006801:Humans; D008134:Long-Term Care / Q000458:organization & administration; D008297:Male; D008875:Middle Aged; D009910:Oral Hygiene / Q000379:methods*; D011050:Policy Making; D015397:Program Evaluation; D011788:Quality of Life; D018570:Risk Assessment; D012648:Self Care; D012866:Skilled Nursing Facilities / Q000458:organization & administration*
keywords: Oral health; continuing care policy; health services administration; interdisciplinary; long-term care