P-24 A clinical audit of xerostomia assessment and treatment practices amongst advanced cancer patients in a palliative care setting

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Abstract

Background

Xerostomia is the subjective sensation of dry mouth. It is the fourth most common symptom in advanced cancer patients and impacts negatively on physical and psychosocial wellbeing. Older age and polypharmacy are risk factors for dry mouth and are common in advanced disease. This study aims to evaluate prevalence of xerostomia, as well as compliance with assessment and treatment practices.

Methods

A retrospective chart audit was conducted on 173 admissions from an in-patient palliative care unit. Data were collected pertaining to patient demographics, cancer diagnosis, medications, oral health assessment and xerostomia treatment. Audit standards were based on local policy as follows: Oral Health Assessment Tool (OHAT) completed on all patients; OHAT completed within one day of admission; oral care plan completed if problem diagnosed; xerostomia treatment prescribed where necessary. Descriptive statistics were used to report compliance with standards. Cohen’s Kappa and Intraclass Correlation Coefficient were used for inter- and intra-rater reliability based on a 10% sample of the dataset.

Results

Palliative in-patients were significantly more likely than the general population to experience dry mouth (p<0.001). 86% of admissions had OHAT completed and 91% of these were on day of admission. Care plans were completed for 76% of patients with oral care needs. Appropriate medications were prescribed for 34% of patients with dry mouth. Inter- and intra-rater reliabilities were high or perfect for all primary outcomes.

Conclusions

Results indicate that oral health is evaluated in the majority of patients, however treatment appears low. This may be partly due to poor instrument design, where non-prescription treatments or ‘treatment unnecessary’ cannot be documented. Existing tools could be amended to reflect patient care needs more accurately. A change project is currently underway within the care setting to improve practice as a result of the study.

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