Mouth Care Neonatal Clinical Guideline - V1.0 February 2021
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Mouth Care Neonatal Clinical Guideline V1.0 February 2021
Summary Mouth Care Procedure Perform hand hygiene and wear clean gloves Assessment of mouth should be done during daily cares using the assessment tool. (Unless score=0, mouth care should be given) Gather articles required for mouth care (cotton tip applicator, gauze, colostrum, sterile water and paper bag) Use clean gauze dipped in sterile water to clean lips and a cotton bud dipped in 0.1ml of colostrum to apply over lips and to coat a thin layer over buccal cavity and tongue Discard all used items including excess milk Document mouth care in intensive care charts, daily feeds/ care record and badger checklist Mouth Care Neonatal Clinical Guideline V1.0 Page 2 of 10
1. Aim/Purpose of this Guideline Oral hygiene is an integral part of total care. Babies in the neonatal unit are more susceptible to nosocomial infections as majority of them are premature. Colostrum is rich in immune agents that can stimulate oropharyngeal associated lymphoid tissue. When colostrum is placed directly into the oral mucosa it can be systemically absorbed and help protect vulnerable infants against infections. Data Protection Act 2018 (General Data Protection Regulation – GDPR) Legislation The Trust has a duty under the DPA18 to ensure that there is a valid legal basis to process personal and sensitive data. The legal basis for processing must be identified and documented before the processing begins. In many cases we may need consent; this must be explicit, informed and documented. We cannot rely on opt out, it must be opt in. DPA18 is applicable to all staff; this includes those working as contractors and providers of services. For more information about your obligations under the DPA18 please see the Information Use Framework Policy or contact the Information Governance Team rch-tr.infogov@nhs.net 2. The Guidance The aim of this document is to outline the advantages of, and provide guidance on the use of colostrum in mouth care. This policy applies to all staff that care for babies admitted to neonatal unit. Oxford dictionary definitions are: Colostrum– The first secretion from mammary glands after giving birth, rich in antibodies. Breastmilk– Milk produced by a woman’s breasts after child birth as food for her child 2.1. Roles and responsibilities Health professionals have responsibilities for development, management and implementation of this guideline as detailed below. 2.1.1. Role of managers The neonatal ward manager is responsible for ensuring monitoring and compliance standards are met as specified in the guideline. 2.1.2. Role of individual staff All neonatal staff members are responsible for practising in accordance with this neonatal guidance document at all times while employed in this trust. Mouth Care Neonatal Clinical Guideline V1.0 Page 3 of 10
2.2. Standards and practice 2.2.1. The fundamental objective of providing mouth care is to maintain the oral mucosa, gums, buccal cavity and lips in good condition. It will also benefit the neonate by: Keeping the oral mucosa moist, soft and intact, thereby reducing oral and systemic infections. Keep lips soft, moist and intact. Removal of debris without damage to mucosa. Prevent oral colonisation of gram negative flora Freshen the mouth and increase the general wellbeing. In a sick preterm neonate it also benefits by: o Providing positive oral experience for the neonate. o Early sensory development of taste and smell. o Odour and taste of colostrum provides a soothing effect and decreases cortisol levels. o Neonate can gain from the advantageous constituents of maternal breast milk as it gets absorbed through the oral mucosa. o Reaffirms mum the importance of her milk as it is a unique contribution from mums to the treatment of their sick baby. 2.2.2. Factors that compromise the oral wellbeing of neonates include: Intubated neonates, surgical babies nursed in prone and babies with jaw abnormalities such as micronathia provides restricted access to oral mucosa causing difficulty in performing oral hygiene and thus mucosal deterioration Hyperthermia can cause dry mouth and coated tongue. Antibiotics can alter the mouth’s natural flora and increase the risk of opportunistic infection such as oral thrush. Some medications and oxygen therapy can cause dry mouth. 2.2.3. Procedure for mouth care Mouth care should be provided along with the daily cares and the frequency depends on the individual needs of the babies based on assessment. It should at least be provided once during the 12 hour shift. Gather the articles required for mouth care prior to initiation of daily care(cotton tip applicator, gauze, colostrum, sterile water and paper bag) Colostrum 0.2 – 0.3 ml should be drawn up in a syringe and labelled properly. It should be used in increments of not more than 0.1 ml to minimize risk of aspiration. Whenever available freshly expressed colostrum should always be the first choice for mouth care. Formula milk should not be used for mouth care. Perform hand hygiene and wear clean gloves. Suction the oral cavity if there are excess secretions or pooling of saliva. Dip clean gauze in sterile water and clean the lips. Discard it in the paper bag. Never re-dip a used swab. Mouth Care Neonatal Clinical Guideline V1.0 Page 4 of 10
Dip a cotton bud in 0.1 ml of colostrum and apply over the lips. If the oral cavity permits roll a thin layer of colostrum over the gum line, buccal cavity and tongue. Discard all used items including any excess milk. Sterile water to be labelled for 24 hours and kept in the baby’s drawer. Document the mouth care in intensive care charts, daily feed/cares record and badger checklist. 2.2.4. Oral assessment Assessment of the oral cavity should be done each time mouth care is provided and should involve observation of Lips and corners of mouth – should be smooth, pink and moist with no signs of dryness, cracks, ulceration and bleeding. Tongue – should be pink, moist and with a shiny appearance of papillae. There should be no cracking, splitting, presence of oral candida, redness and ulceration. Saliva – should be thin and watery. Mucous membranes – should be pink and moist. Check for ulceration or candida. Assessment of mouth Undertaken at each mouth care (Score written on chart where mouth care indicated and care plan) Lips Observation 0=smooth, pink, moist 1=coated, dry or cracked 2=ulceration or bleeding Tongue Observation 0=pink, moist papillae 1=coated/shiny + >/4suction) Consistency of oral Observation 0=Clear and clean secretions 1=Thin and mucoid 2=thick and discoloured *Adapted from Jiggins M, Talibot J(1999) mouth care in PICU, pediatric nursing Dec/Jan11;(10):23-26 2.3. Implementation This policy is to be communicated to all health care staff that have any contact with the neonates and families. Neonatal team members have the responsibility of supporting all parents to be confident in providing mouth care. All new staffs will be orientated to the policy on initiation of neonatal duty. Information will be given to the paediatrics team as well to support appropriate mouth care. Mouth Care Neonatal Clinical Guideline V1.0 Page 5 of 10
3. Monitoring compliance and effectiveness Element to be Compliance with policy monitored Lead Neonatal Guidelines Lead- Chris Bell; Neonatal Consultant Tool Adherence to guidelines will be monitored as part of the ongoing audit process on a Word or Excel template Frequency As dictated by audit findings Reporting Neonatal Audit and Guidelines Meeting arrangements Acting on Neonatal Medical and Nursing teams recommendations and Lead(s) Change in Required changes to practice will be identified and actioned within practice and 3 months, immediately if required. A lead member of the team will lessons to be be identified to take each change forward where appropriate. shared Lessons will be shared with all the relevant staff/stakeholders 4. Equality and Diversity 4.1. This document complies with the Royal Cornwall Hospitals NHS Trust service Equality and Diversity statement which can be found in the 'Equality, Inclusion & Human Rights Policy' or the Equality and Diversity website. 4.2. Equality Impact Assessment The Initial Equality Impact Assessment Screening Form is at Appendix 2. Mouth Care Neonatal Clinical Guideline V1.0 Page 6 of 10
Appendix 1. Governance Information Document Title Mouth Care Neonatal Clinical Guideline V1.0 This document replaces (exact New title of previous version): Date Issued/Approved: January 2021 Date Valid From: February 2021 Date Valid To: February 2024 Directorate / Department Lekshmi Balakrishnan; Neonatal Staff Nurse responsible (author/owner): Contact details: 01872 252667 Guidance on appropriate mouth care for neonatal Brief summary of contents inpatients Suggested Keywords: Mouth care, neonatal RCHT CFT KCCG Target Audience Executive Director responsible Medical Director for Policy: Approval route for consultation Neonatal Guidelines team and ratification: General Manager confirming Mary Baulch approval processes Name of Governance Lead confirming approval by specialty Caroline Amukusana and care group management meetings Links to key external standards No Related Documents: None required Training Need Identified? No Publication Location (refer to Policy on Policies – Approvals Internet & Intranet Intranet Only and Ratification): Document Library Folder/Sub Clinical/ Neonatal Folder Mouth Care Neonatal Clinical Guideline V1.0 Page 7 of 10
Version Control Table Version Changes Made by Date Summary of Changes (Name and Job No Title) Lekshmi September V1.0 Initial issue Balakrishnan; 2020 Neonatal Staff Nurse All or part of this document can be released under the Freedom of Information Act 2000 This document is to be retained for 10 years from the date of expiry. This document is only valid on the day of printing Controlled Document This document has been created following the Royal Cornwall Hospitals NHS Trust Policy for the Development and Management of Knowledge, Procedural and Web Documents (The Policy on Policies). It should not be altered in any way without the express permission of the author or their Line Manager. Mouth Care Neonatal Clinical Guideline V1.0 Page 8 of 10
Appendix 2. Equality Impact Assessment Section 1: Equality Impact Assessment Form Name of the strategy / policy /proposal / service function to be assessed Mouth Care Neonatal Clinical Guideline V1.0 Directorate and service area: Is this a new or existing Policy? Neonatal New Name of individual/group completing EIA Contact details: Neonatal Guidelines Group 01872 252667 1. Policy Aim Who is the strategy / policy / The aim of this document is to outline the advantages of, proposal / service and provide guidance on the use of colostrum in mouth care. function aimed at? 2. Policy Objectives As above 3. Policy Intended Outcomes To improve the well-being of patients by offering the appropriate management of patients 4. How will you measure Audit/Multidisciplinary team weekly discussion/incidents/risk the outcome? management 5. Who is intended to benefit from the Patients and staff policy? 6a). Who did you Local External Workforce Patients Other consult with? groups organisations x b). Please list any Please record specific names of groups: groups who have been consulted Neonatal Guidelines Group about this procedure. c). What was the outcome of the consultation? Approved- 16th September 2020 Mouth Care Neonatal Clinical Guideline V1.0 Page 9 of 10
7. The Impact Please complete the following table. If you are unsure/don’t know if there is a negative impact you need to repeat the consultation step. Are there concerns that the policy could have a positive/negative impact on: Protected Yes No Unsure Rationale for Assessment / Existing Evidence Characteristic Age X Sex (male, female non-binary, asexual X etc.) Gender reassignment X Race/ethnic Any information provided should be in an communities accessible format for the family’s needs – i.e. /groups X available in different languages if required/access to an interpreter if required Disability (learning disability, Those families with any identified additional physical disability, needs will be referred for additional support as sensory impairment, appropriate- i.e. to the Liaison team or for X mental health specialised equipment. problems and some Written information will be provided in a format to long term health meet the family’s needs e.g. easy read, audio etc conditions) Religion/ other beliefs X Marriage and civil partnership X Pregnancy and maternity X Sexual orientation (bisexual, gay, X heterosexual, lesbian) If all characteristics are ticked ‘no’, and this is not a major working or service change, you can end the assessment here as long as you have a robust rationale in place. I am confident that section 2 of this EIA does not need completing as there are no highlighted risks of negative impact occurring because of this policy. Name of person confirming result of initial Neonatal Guidelines Group impact assessment: If you have ticked ‘yes’ to any characteristic above OR this is a major working or service change, you will need to complete section 2 of the EIA form available here: Section 2. Full Equality Analysis For guidance please refer to the Equality Impact Assessments Policy (available from the document library) or contact the Human Rights, Equality and Inclusion Lead debby.lewis@nhs.net Mouth Care Neonatal Clinical Guideline V1.0 Page 10 of 10
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