EVIDENCE UTILISATION The implementation and evaluation of an oral healthcare best practice guideline in a paediatric hospital Annette Dickinson RGON, PhD, 1,2,3 Kathy Peacock B.A (Soc Sci), 1,2 Nicola Fair BHSc (Nursing), PGDipHSC (ANP), 1,2 Mercy Thomas RN, MScN, 1,2 Rebecca Nicol RN, PGCerT, 1,2 Janet Mikkelsen BSc (Hons), Adv.Dipl. R(Comp)N, 1 Judy Haslemore RGON, PGCert, 1,2 Linda Chapman RGON, RM, 1,2 Nic Garrett MSc 3 and Lisa Johnstone RN, MHPrac, PGDipHSci (ANP), BHSci 1,2 1 Starship Children’s Hospital, 2 Centre of Evidence Based Healthcare Aotearoa: A collaborating centre of the Joanna Briggs Institute, Auckland City Hospital, 3 Faculty of Health AUT University, North Shore Campus, Akoranga Drive, Northcote, Auckland, New Zealand Abstract The oral health of the New Zealand population now compares unfavourably with other countries. A number of strategies have been introduced at a government and health provider level to improve the oral health status of children. One such strategy was the introduction of a recommended best practice (RBP) within Starship Children’s Hospital. Nursing practice was evaluated 2 weeks prior and 6 months post-implementation of the RBP using a survey technique. While there was no significant change in practice post-introduction of the RBP, awareness regarding the oral health care needs of children while in hospital has been improved. This study provides increased understanding in regard to the oral healthcare practices of paediatric nurses, the influences on evidence-based practice change and health education and promotion within an acute paediatric hospital. Key words: evidence-based practice, health promotion, implementation, nursing, oral health, paediatrics. Introduction Until recently the oral health of New Zealand children was considered acceptable and comparable to other first world countries. However, since the mid 1990’s, there has been a disturbing trend in the pattern of child oral health with an increase in the prevalence and severity of child dental decay. There are marked disparities between ethnic groups and regions, particularly those which have non-fluoridated versus fluoridated water. 1,2 In 2004, only 52% of children were reported as caries free. 2 New Zealand’s oral health statistics now compare unfavourably with similar countries such as Australia and the UK. Because of this alarming trend improving oral health has become one of the 13 population health objectives stated in the New Zealand Health Strategy 3 and one of the 12 priorities for Whakatataka Maori Health Action Plan. 4 In response to this national strategy and the regional Child Health Improvement Plan 5 the senior nurses at Starship Children’s Hospital decided to review the oral healthcare practices of inpatient nurses and implemented a recommended best practice guideline (RBP) to ensure that inpatient nurses were playing their part in improving the oral care of children while in hospital. Little is known about the oral healthcare practices of pae- diatric nurses with most studies evaluating nursing practice in relation to oral care carried out in high risk areas or adult populations (intensive care unit, oncology, older adult, dis- abled). Studies within paediatric areas have been largely confined to paediatric intensive care unit (PICU), 6 oncology 7 and disabled children 8 with most reporting that oral care is generally under reported, undiagnosed and inadequately documented by nurses and doctors. 8,9 Oral care is often reported as being ritualistic with nurses often using oral swabs and solutions with little evidence to support their practice while at the same time underutilising routine clean- ing with toothbrush and toothpaste, a strategy well sup- ported by research in maintaining oral care and reducing dental disease. 6,10,11 Studies have also shown a knowledge deficit and poor education (post-registration and under- graduate) of nursing staff in relation to best oral care prac- tice. 6,8,9 Assessment tools and best practice guidelines have been developed largely for specific at risk patient groups, and introduction of these into the practice setting has Correspondence: Annette Dickinson, Nursing Development Unit, Level 15, Support Building, Auckland City Hospital, Private Bag 92024, Auckland. Email: annette@adhb.govt.nz doi:10.1111/j.1744-1609.2008.00120.x Int J Evid Based Healthc 2009; 7: 34–42 © 2009 The Authors Journal Compilation © Blackwell Publishing Asia Pty Ltd