A quality improvement initiative to increase identification of oral disease and dental care in pregnancy
Carrie J. Kamp, DNP, APRN, FNP-C; Sandi Tenfelde, PhD, APRN, WHNP-BC
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Purpose: Oral health is an important part of overall health, and oral disease has been associated with poor perinatal outcomes. While it is widely recognized that oral healthcare is safe and important during pregnancy, less than one-half of pregnant women visit the dentist during their pregnancy. Limited evidence is available to support interventions to increase the number of pregnant women who visit the dentist during the course of their pregnancy. This quality improvement project seeks to implement and evaluate an evidence- based intervention aimed at identifying women at high risk for oral disease as well as increasing dental visits among pregnant women at a Federally Qualified Health Center.
Summary: A 3-fold intervention is being implemented to address this need: education of obstetric (OB) nursing staff regarding the importance of oral healthcare during pregnancy, implementation of the 2 question Maternal Oral Screening (MOS) tool at initial OB visits, and follow-up text message/e-mail reminders to remind OB patients to visit the dentist during pregnancy. Evaluation of nursing staff education was done with pre and post-tests. Evaluation of screenings and reminders will be done through review of electronic medical record data.
Outcomes: Education: 45 nursing staff attended the educational intervention. Overall average test scores improved from 41% to 75% (p<0.001). MOS screening: Thus far, there have been 48 initial OB patients. 47 were screened for oral disease using the MOS tool (98% screened). 43 women screened positive for risk of oral disease, and 22 were referred for dental care (51% referred). During a comparable time period in 2018, only 6 OB patients were referred for dental care. Further data review pending.
Implications: This project provides a low-cost intervention that requires little additional implementation time in the clinical setting. If successful, an increased number of women will seek dental care during their pregnancy, potentially improving health outcomes. Future research could be done to assess feasibility of these interventions in other at-risk populations.
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