ABSTRACT
ContextOral health knowledge is fundamental to ensure all healthcare teams achieve holistic patient care within community settings. During the COVID-19 pandemic, dentists were redeployed to district nursing teams to support wider healthcare service demands, where patients exhibited poor oral health and deficits in staff oral health knowledge were observed.During restoration and recovery of services, three post-graduate dental trainees launched a trust wide training needs analysis amongst non-dental professionals working across Birmingham Community Healthcare NHS Foundation Trust. This identified a lack of confidence in providing mouthcare and oral health advice to patients. As a result, the team created the Oral Health Ambassador Programme, placing oral health leadership with local nursing team leads and providing the resources to champion oral health for patients in their care. Creation of an online training module supported a deficit in oral health training.Issue/ChallengeWorking within a domiciliary setting provided a unique opportunity to experience first-hand the challenges nursing teams face in providing oral health care to their patients. Leading in a novel environment meant incorporating oral health into a holistic care plan whilst overcoming the time restraints of an already stretched workforce during a global pandemic.Assessment of issue and analysis of its causesOn return to service, a trust wide oral health training needs analysis was created and distributed to all patient facing non-dental staff across BCHC. To maximise stakeholder engagement and response rate, promotion via trust publications and senior endorsement within each division was essential.The results of the training needs analysis were used to design a community specific oral health training package and led to the creation of the ‘Oral Health Ambassador' scheme. Results were disseminated alongside the launch of the training package to district nursing teams and presented regionally to 300 trust leaders at the senior leadership brief and to multidisciplinary colleagues at trust quality improvement forums.ImpactResults of the training needs analysis identified that 90% of respondents had concerns about patient oral health. Despite this, 68% had received no previous oral health training. The main barriers to provision of mouthcare and delivery of oral health advice were lack of training, time, insufficient patient cooperation and lack of equipment. A likert scale identified lower confidence levels in providing support for patients with learning difficulties or challenging behaviour and in accessing resources to support patients and families.InterventionThe Oral Health Ambassador scheme was created with the patient and healthcare provider at its core. The survey results provided key themes for learning which were used to divide the online learning into modules, making specific topics easily accessible. Dedicated time was provided to ensure training was part of the working day.To incorporate learning into their daily practice, a local lead was identified in each team as the Oral Health Ambassador, bridging the gap between dental and nursing teams and acting as a direct link for dental support within nursing teams. Oral Health Ambassadors are leading team training and raising resource awareness.Oral health boxes were created and delivered to teams providing an easily accessible wealth of oral resources for providers, patients and families. Equipment was included with information for use and adaptability for individual patient need.Involvement of stakeholders, such as patients, carers or family members:Stakeholder mapping included direct input from district nurses and Health Care Assistants. Piloting the scheme across a variety of sectors provided reassurance that the training would benefit all allied health professionals across the trust.Key MessagesCommunity healthcare staff have a unique opportunity to support oral health needs of vulnerable community patients. Redeployment provided a unique opportunity to lead in changes for oral health pr motion in the community and create local leads, Oral Health Ambassadors, that can continue to champion oral health post pandemic.Lessons learntWhilst dental teams took initial responsibility, passing this onto local leads will create key ambassadors within the teams, passionate about improving patient oral health and providing support for peers to do the same.Measurement of improvementPreliminary data taken from online learning pre-and-post knowledge survey shows an improvement in knowledge and increased confidence levels. Further feedback awaits.Strategy for improvementFollowing on from a successful launch of the scheme, the team suggests creation of an oral health mobile app would allow a wealth of up-to-date information, guidance and resources at the click of a finger.
ABSTRACT
After its emergence in late November/December 2019, the severe acute respiratory syndrome coronavirus 2 virus (SARS-CoV-2) rapidly spread globally. Recognizing that this virus is shed in feces of individuals and that viral RNA is detectable in wastewater, testing for SARS-CoV-2 in sewage collections systems has allowed for the monitoring of a community's viral burden. Over a 9 month period, the influents of two regional wastewater treatment facilities were concurrently examined for wild-type SARS-CoV-2 along with variants B.1.1.7 and B.1.617.2 incorporated as they emerged. Epidemiological data including new confirmed COVID-19 cases and associated hospitalizations and fatalities were tabulated within each location. RNA from SARS-CoV-2 was detectable in 100% of the wastewater samples, while variant detection was more variable. Quantitative reverse transcription PCR (RTqPCR) results align with clinical trends for COVID-19 cases, and increases in COVID-19 cases were positively related with increases in SARS-CoV-2 RNA load in wastewater, although the strength of this relationship was location specific. Our observations demonstrate that clinical and wastewater surveillance of SARS-CoV-2 wild type and constantly emerging variants of concern can be combined using RT-qPCR to characterize population infection dynamics. This may provide an early warning for at-risk communities and increases in COVID-19 related hospitalizations.
ABSTRACT
The COVID-19 pandemic has placed increased strain on many aspects of the NHS. Dentists have been identified as having skills transferable to support community nursing teams as part of the redeployment response. This article aims to explore the roles dentists have undertaken within the community setting and reflect on dentists' transferable skills, training and personal experiences during redeployment. Despite differences in healthcare delivery, both professions share skills surrounding professionalism, communication, raising concerns and consent. Community nurses have supported dentists through specific training and competencies so that the latter are equipped with skills to support roles including wound care, catheter care and medication administration. Dentists have been well-received by community nursing colleagues and patients during redeployment. This experience has enabled redeployed dentists to establish new skillsets while improving their appreciation for the fundamental role that community nurses play within society.