Proposed Topic (Most preferred): :
Clinical Safety and Quality Service II (Projects aiming to enhance clinical safety and outcomes, clinical governance / risk management)
Proposed Topic (Second preferred): :
Clinical Safety and Quality Service I (Projects aiming to improve efficiency and effectiveness of care delivery to meet international standards)
Authors (including presenting author) :
Wong SF(1), Chu YS(1), Yeung CH(1), Yung WK(1), Chan CYC(1), Lo WPJ(1), Lee CH(1), Kwan YFE(1), HP Shum(1)
Affiliation :
(1)Intensive Care Unit, Pamela Youde Nethersole Eastern Hospital
Introduction :
The provision of adequate oral care is essential for maintaining good oral hygiene in intubated patients and preventing respiratory complications such as ventilator-associated events (VAE) and unplanned extubation. A well-designed ETT holder may enhance oral care efficiency.
Objectives :
To compare oral health status and ETT securement in patients using ETT holders versus conventional tape.
Methodology :
In February 2023, the ETT holder with bite block was first introduced to selective cases in Intensive Care Unit (ICU). A series of education sessions and return demonstrations had been arranged before its full implementation in August 2023. During this trial period, prospective surveys and observations were conducted. A quantitative tool, Modified Beck Oral Assessment Score, (mBOAS) was adopted to monitor any significant changes in oral health. This tool guides a meticulous inspection of the oral cavity including the lips, oral mucosa and gingiva, tongue, dental plaque, and saliva. In addition, unplanned ETT extubation incidents were recorded and analysed. Furthermore, a nurse satisfaction survey was conducted to collect the user’s feedback on the new appliance.
Result & Outcome :
Since implementation, the ETT holder has been applied to approximately 350 eligible patients. There was no significant difference in mBOAS scores between the ETT holder group (7.65/20) and the conventional tape group (7.34/20); while the ETT holder group had a lower rate of lip lesions found (11.4% vs. 27.1%). Furthermore, toothbrushing compliance was low in both groups (17.6% and 11.3%). This result was alarming. For unplanned extubation, the rate (in 1000 ventilator days) dropped significantly from 4.9 in 1Q 2023 to 1.4 and 2.6 in 3Q & 4Q 2023.
