Oral health care and hydration are ongoing quality of life issues in long term care. Since September, five fourth-year nursing students from the University of Saskatchewan have been working to implement hydration and oral health care projects at Parkridge Centre, a long term care home within Saskatoon Health Region.

Students began both projects by familiarizing themselves with the home, the interprofessional staff, and residents. Those students focusing on the hydration project observed fluid intake of the residents and identified routines on the neighbourhoods.

Water bottles had been purchased by Parkridge Centre and the students developed a plan for neighborhood-by-neighborhood introduction of them, attaching them to wheelchairs or walkers, or making them available in residents’ rooms. A discussion among the interprofessional team identified the minimum amounts residents should take in, and identified a target of one bottle of fluid per day per resident.

The dietitian outlined that all fluids contributed to hydration, lessening the focus on water-only consumption, and removing barriers to intake. A process for water bottle cleaning and distribution was organized with the help of staff input.

Students are continuing to roll out the water bottles onto consecutive neighbourhoods as appropriate. A fluid tracking sheet is being trialed to help staff identify residents at ongoing risk of dehydration.

The initial step of the oral health project was to orient the student to the process of oral assessment and care provision; this was followed by an audit of the current practice in each of the neighbourhoods. Observation and participation in morning care as well as communication with the staff and residents on how to make oral health a part of daily care was a component of this ongoing process.

Saskatoon Health Region has recently increased their focus on oral care in long term care with the introduction of a dental program coordinator to Parkridge Centre; this coordinator will be coming in to increase consistency and provide support to staff team leaders on each neighborhood.

The nursing students and their display at the October 27 health fair.

The nursing students and their display at the October 27 health fair.

To provide a fun educational experience for residents, staff and visitors, the students put on a health fair on October 27. It was a successful day with a large number of individuals participating in games, winning prizes, and eating food. Water breaks occurred throughout the day and a thickened fluid testing station was set up for staff.

A series of educational poster boards have been organized for staff to review, and a brochure created outlining the importance of the projects intimately links oral care and hydration: assessing oral mucous membranes is a component of the oral care and hydration assessment.

As students come to the end of their time at Parkridge Centre, they have devised tools to sustain the hydration project. A decision tree, developed with the help of Karli, the Parkridge Centre’s Speech and Language Pathologist, has been developed to help increase hydration and keep residents safe when offering fluids.

The next suggested step in this process will be the development of a bedside assessment swallowing guide for nursing staff.

A summary report is being compiled, and will be shared with the Parkridge management staff, to help identify aspects of implementation that are complete, proposed challenges, and recommendations for future action. This has been an excellent learning experiencing, highlighting the challenges that are faced when trying to implement quality improvement projects.

Submitted on behalf of the 4th year U of S College of Nursing students