What Is Proper Oral Care For An NPO Resident?

- Michael Brevda

Proper oral care for an NPO resident involves:

  1. mechanical efforts (brushing teeth) once every AM and PM shift;
  2. rubbing the teeth, tongue, gums and the side of the mouth with chlorhexidene 0.12% once every AM and PM shift;
  3. moist swab every 2 hours for moisture relief.

Oral care is incredibly important for a resident who has swallowing issues.  If you believe your loved one suffered nosocomial pneumonia, aspirational pneumonia or wrongful death because of improper oral care, call the experienced attorneys at Senior Justice Law Firm for a free consultation.

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Why Is Proper Oral Care For An NPO Resident Important?

Proper oral care for an NPO resident can save lives.  NPO residents are residents who cannot swallow foods or liquids due to swallowing issues.  Proper oral care for an NPO resident can prevent aspirational pneumonia, which is one of the biggest killers at nursing homes and assisted living facilities.  Pneumonia is particularly bad for nursing home residents, as it is the most prominent reason for re-hospitalizations and generally increases the length of hospital stays by up to 40 days.

Additionally, an unexperienced CNA who is unaware of proper oral care for an NPO resident might provide things such as liquid mouthwash, which can lead to choking.  Sadly, choking deaths are prevalent at nursing homes and assisted living facilities.

Proper Oral Care For An NPO Resident

Oral care is properly brushing the resident’s teeth at least twice a day:

  • prior to brushing, it is integral that the staff member washes her/his hands to prevent germs from entering the residents mouth.
  • the brushing should be done with a plak vac toothbrush, which has a suction device.  This special toothbrush prevents accumulations of water and spit from accumulating in the throat of a resident, which can be deadly for a resident with swallowing issues.
  • Brushing the teeth alone is not enough – instead, it is necessary to brush the teeth, gums, tongue, palate and inside of the cheeks.
  • If the resident has dentures, they should be rinsed in a cleaning solution.

In the alternate, oral care for an NPO resident can be accomplished by:

  • placing 15ml of chlorhexidene 0.12% in a cup,
  • soaking a toothette in the liquid,
  • rubbing the aforementioned parts of the mouth in a slow circular motion, and
  • suctioning out the remnants.

It is important not to use suction and not rinse, because rinsing can lead to inadvertent aspirational events.

Who Is At Risk For Aspirational Pneumonia Or Choking Due to Improper Oral Care?

Proper oral care for an NPO resident is important, but other residents might be at risk for pneumonia if provided improper oral care.  Residents with the following conditions are at risk for pneumonia due to improper oral care:

  • Suction use,
  • Chronic Obstructive Pulmonary Disease (COPD),
  • Congestive Heart Failure (CHF),
  • the use of feeding tube for nutrition,
  • delirium,
  • significant weight loss,
  • dysphagia and swallowing issues,
  • UTI,
  • a mechanically soft diet or thin liquid restriction,
  • requiring staff assistance for eating, and
  • age

 

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