Cut care or cut waste? Changing Oral Care practice in St James Hospital

Background: In January 2014 the author's institution completed a quality improvement project to improve oral care practice. Our team included nurses, pharmacists, procurement staff, speech and language therapists and... [ view full abstract ]

Background:
In January 2014 the author's institution completed a quality improvement project to improve oral care practice. Our team included nurses, pharmacists, procurement staff, speech and language therapists and infection prevention and control staffs who collaborated to promote evidenced based oral care and reduce the inappropriate use and associated cost of a type of mouthwash that should be used for patients with MRSA but was often used inappropriately.

Aim and objectives:
1. Educate nursing staff on best practice in oral care.
2. Reduce inappropriate use of Corsodyl mouthwash and deliver cost savings.
3. Reintroduce toothbrushes and toothpaste to ward stock.

Description of Innovation:
72 nurses across 10 wards were surveyed on oral care practice. The survey results indicated that 58% of nurses surveyed often used mouthwash that was inappropriate for regular oral care.
We compared MRSA eradication treatment rates vs. usage of Corsodyl® mouthwash on a sample of four wards over one year. The sample wards used a total of 63 out of 451 bottles Corsodyl mouthwash appropriately (for patients with MRSA). Therefore total of 388 bottles were used inappropriately for patients without MRSA at a cost of €2096.20.
We used this data to gain support and drive action on the completion of our objectives.

Impact of innovation:
The CNM’s on all in-patient wards were educated about oral care practice and the changes in oral care products.
We reintroduced toothpaste and toothbrushes into ward stocks for patients without their own supply.
Corsodyl® mouthwash was limited to a maximum stock level of two bottles per ward in January 2014.
In January 2015 we reviewed the cost and usage of Corsodyl® for 2014.
Our changes have resulted in savings of €17,065.46 for 2014. Money which can usefully employed elsewhere.

Conclusions and implications:
Our project highlights how simple changes can reduce waste and therefore provide cost savings. Healthcare costs are rising across the world unfortunately cost can be a deciding factor in choices around treatment provision. In straightened economic times we would ask healthcare professionals to ponder the question- should we cut care or can we cut waste instead?