1377 Getting our teeth stuck into the root of the problem, opportunistic public health messaging within an A&E department

• Published in: Archives of disease in childhood 2022-08, Vol.107 (Suppl 2), p.A31-A31
• Main Authors: Verow, Rosanne, Davey, Nicola, Ajitsaria, Richa
• Format: Article
• Language: English
• Subjects: Abstracts; Behavior Change; Children; Decay; Dental caries; Dentistry; Dentists; Departments; Health problems; Medical personnel; Medical Services; Patients; Pediatrics; Public health; Teeth
• ISSN: 0003-9888; 1468-2044
• DOI: 10.1136/archdischild-2022-rcpch.50

AimsTooth decay remains the commonest reason for hospital admissions of children in England. Doctors and nurses see children in A&E everyday but often don’t address this problem and rarely ask when a child last saw a dentist. With A&E departments busier than ever could A&E attendances be an opportunity to help prevent the spiralling crisis of tooth decay? Our objective was that by March 2022 at least 8 out of 10 children between the ages of 1-17years who present to paediatric A&E will be asked when they last saw a dentist.MethodsAs part of the ‘LSP Improve ONE Thing’ programme we worked to understand the problem using process maps and fishbone diagrams. We engaged staff and patients through ‘share and learn’ activities to better address the problem. We chose the measure of how many patients triaged to the paediatric A&E department were asked when they last saw a dentist and formulated change ideas. The impact of these change ideas were captured using a Plan-Do-Study-Act (PDSA) record sheet and retrospective assessment of patients notes allowed a run chart to be formulated.ResultsSince February 2021 4 PDSAs have been tested. The first based around information sharing using email, instant messaging, posters, micro teaching, and case-based discussion. Secondly through ensuring information leaflets were present in the department on how to find an NHS dentist. Thirdly through sharing daily fun dental facts. The fourth involved creating a departmental leader board with prises and individual thank you letters for the staff who make the de it into the top 5.Within our department there was a great amount of support and agreement of the need to address this issue, but this did not initially translate into action. SHOs and senior members of the nursing team were quickest to incorporate the change and the competitive element helped to create a fun way to entice people into making behavioural changes. Self reporting showed that some triage nurses were able to ask over ten patients per shift when they had last seen the dentist and where necessary inform them how they could get an NHS dentist for free. 70 sets of notes were retrospectively reviewed, and a behavioural change was seen however at present this has not been a statistical shift.ConclusionBehavioural change is always challenging especially when asking busy A&E staff to think outside of acute medical care and focus holistically on the bigger issues facing our children. Whilst we have not yet reached the desired