Debra McKenzie¹, Eilleen Shepherd², Jacinta Pitt³, Carolyn Bourke⁴

1 Toowoomba Oral Health, Darling Downs Hospital & Health Service, PMB2 Toowoomba 4350.

debra.mckenzie@health.qld.gov.au

2 Toowoomba Oral Health, Darling Downs Hospital & Health Service, PMB2 Toowoomba 4350.

eilleen.shepherd@health.qld.gov.au

3 Rural Health and Aged Care, Darling Downs Hospital & Health Service, Mt Lofty Nursing Home, Rifle Range Road, Toowoomba,4350 jacinta.pitt@health.qld.gov.au

4 Telehealth Service, Darling Downs Hospital & Health Service, Mt Lofty Nursing Home, Rifle Range Road, Toowoomba,4350 carolyn.bourke@health.qld.gov.au

Background:

Maintaining mature mouths utilising teledentistry is an innovative model of care enabling Darling Downs Hospital and Health Service’s (DDHHS) Residential Aged Care Facility (RACF) residents to have oral checks and dental reviews via a live streaming videoconference appointment with a Dentist. This integrated approach is between DDHHS’ Oral Health Clinic (OHC), Telehealth Team, seven RACFs, as well as RACF residents and their families.

Methods:

DDHHS’ TeleDentistry program was initially trialled in January 2014 using a dental probe connected to video conference equipment. The trial highlighted some technical issues which had to be overcome and also provided the opportunity to fine tune operational, administrative and nursing processes. Once the issues were addressed, the trial was recommenced at DDHHS’ Mt Lofty Nursing Home in Toowoomba in November 2014.

The Oral Health Therapist (OHT) visits the RACF and performs a chart audit, reviewing dental care plans. Each consenting resident receives an oral review in the privacy of their own room. The oral health therapist records the dental review and management plan in the resident’s record in collaboration with the Registered Nurse (RN).  If the OHT finds an issue that requires further investigation, a referral is made by the RN for the resident to be reviewed by a Dentist via Tele Dentistry. A time is scheduled where the Oral Health Therapist uses live streaming of the RACF resident via an inline camera. The Dentist views the live feed from their office and advises on appropriate treatment to commence locally, or advises that the resident is required to be seen in person at the OHC.

Results:

The following outcomes have been achieved:

• 204 residents have had a dental assessment, 57 have had a tele-dental referral/consultation and 16 have required further appointments at the dental clinic.
• Increased awareness of residents’ oral health needs and oral health requirements
• Reduction in QAS and nurse escort time and costs for transporting residents to Oral Health Clinics
• Addresses a major barrier for residents accessing appropriate oral health care
• Reduction in the number of inappropriate referrals to a dentist by first screening residents
• More efficient use of Dentist time
• Minimum disruption to resident’s daily routine
• Patient comfort maintained

• All residents are up to date with yearly visits
• Proactive approach finding areas of concern before they become a problem to the residents i.e. pain
• Staff are becoming more in-tune with technological advances

Discussion:

TeleDentistry has allowed residents to receive optimal dental care while remaining in their own surroundings and eliminated the need for frail residents to be transported to the OHC via ambulance with a nurse escort. To improve the knowledge, skills and attitude of RACF staff in oral health, each nurse working in a RACF is required to undertake mandatory online training regarding oral health via the DDHHS online learning portal “Darling Downs Learning Online” (DDLOL). Future objectives include introducing the program into private aged care facilities and investigating different technology.