May 12, 2008 the frazier water protocol is part of speech therapy. This handout explains what to expect if you are on free water restriction while you are in the hospital. Mar 12, 2017 please read below a message from the principal investigator of the research from abilene christian university. Frazier water protocol what is the frazier water protocol. This is an informational handout for patients with syndrome of inappropriate antidiuretic hormone siadh. It was developed by kathy panther, ms, cccslp, inpatient rehabilitation director at the frazier rehab institute in louisville, ky 22 years ago. A speechlanguage pathologist will determine if a patient is a good candidate for the protocol and will help implement the guidelines. Methods the rhc study was a prospective, randomized, controlled pilot study conducted at riverview health centre, in. What are the stated uses and guidelines of the protocol. Gf strong water protocol npo patients are not permitted water unless stipulated by a specific order for the water protocol order is required for water protocol carlaw, caren. Downloadable patient educational materials for kids and parents.
Patient s and caregivers often express concern that longterm orders for thickened liquids or tube feedings without an option for water or ice chips denies a very primitive and basic drive to refresh the senses. Features of fraziers program include the points listed below. This is an informational handout on fluid restrictions for patients with heart disease, including congestive heart failure. Dysphagia handout, printable pdf download to easily share information with patients and caregivers. As an undergraduate student at abilene christian university acu in the communication sciences and disorders program, i extend an invitation to you to participate in a research survey regarding the impact a. If a drink of water is aspirated, it will be absorbed by the lung mucosal tissues without harm. Understanding medicare may actually appropriately begin with an understanding of what medicare is not. The free water protocol offers a possible solution to the dilemma of keeping our patient. Semantic scholar extracted view of the frazier free water protocol by kathy. The frazier free water protocol is widely administered in the usa and canada. Recent studies have shown that small amounts of water does not. A water protocol is a set of guidelines that allows access to water for selected patients with thinliquid dysphagia in order to improve hydration and to provide an adjunct to thickened liquids. You may drink water after brushing or swabbing your teeth until you take your first bite of food. Mar 25, 2015 what are the stated uses and guidelines of the protocol.
Increases family and patient compliance with modified diets and decreases rates of dehydration by allowing individuals with dysphasia to consume water within the guidelines of the protocol guidelines for the frazier water protocol at the frazier rehabilitation center panther. Likewise utilizing the frazier free water protocol, requires good oral care. The presenter is the best source when it comes to the free water protocol and has a wealth of experience and knowledge on this and oral care programs. Pdf effects of a free water protocol on inpatients in a. Water has a neutral ph, whereas other thin fluids such as coffee, tea, milk or juice do not.
It is generally accepted in clinical circles that the decision to allow oral water intake in an aspirating patient requires management of the pneumonia. According to a study over the span of six years, those who drank at least five glasses of water per day were 41. Asha, 2009 exclusion and supervision criteria frazier free water protocol exclusion. The frazier free water protocol fwp, developed by the frazier rehabilitation institute panther, 2005, is an option available as part of dysphagia rehabilitation that allows patients with dysphagia who are on diet restrictions that include thickened liquids to also have regular water as part of their diet. Free water protocol and dietary compliance dysphagia cafe. Use this worksheet to initiate education with your patients who have copd and dysphagia. Dysphagia patients on thickened fluids or nothing per mouth npo are allowed water between meals. The frazier free water protocol perspectives on swallowing. An electronic search of the embase, cinahl and medline databases was completed up to july 2016. To drain press the wet toothette against the glass in a turning motion so that water can be drained out as much as possible.
Thickened coffees and fruit juices are really good btw try some of the thickened stuff yourself, you may feel reassured that its not really totally unpalatable. To reduce the risk of thin liquid aspiration, patients are often. Perspectives on swallowing and swallowing disorders dysphagia 14. Swallowing and swallowing disorders descriptionuse. Use simple words, avoid jargon, talk directly to the patient, and explain things as you might to your grandmother or a. Strict npo may be ordered by a physician order is not required not required for water protocol gf strong water protocol npo patients are not permitted water unless stipulated by a specific order for the water protocol order is required for water protocol. Medications are not to be taken with water, as pills may be washed into the lungs. Patients with extreme coughing or choking during water intake are. The specifics of the free water protocol will be covered in great detail including assessment of which patients can and cannot be managed safely on free water. It is neither free, nor is it a the laymans guide to alzheimers disease elderly care tips medicare made easy.
No water is allowed during meals or for 30 minutes after meals. Download print patient handouts healthcare toolbox. Nsw speech pathology evidence based practice interest. The main features of the protocol, either straight or modified, is the use of plain water ad lib, but only apart form meal times and after excellent oral hygeine has been done. As such, it was not developed for, nor is there evidence supporting its use with, acute or critically hospitalized patients, or residents of nursing facilities who. The water protocol was developed for nonacute patients in rehabilitation, i. The frazier free water protocol was developed with the aim of providing patients with dysphagia an option to consume thin i. Patients who received frazier water protocol were compared to two no.
Good oral hygiene is a key ingredient of the water protocol. The handout describes the risks, benefits, and guidelines around the protocol and is appropriate for staff, patients, families, caregivers, and therapists. The frazier water protocol appears to be an effective method of providing water to patients with dysphagia known to aspirate, meeting quality of life needs, and, minimising risk of dehydration. The original frazier free water protocol ffwp was developed for the adult stroke. The intervention group for whom the free water guidelines were implemented did not differ significantly from the control group in rate of development of aspiration pneumonia. The frazier water protocol fwp allows residents with dysphagia free access to water with little to no incidence of aspiration pneumonia. Free water protocol speech language pathology cleveland. At kessler institute for rehabilitation, a 72 bed acute rehabilitation hospital, a comprehensive free water protocol was developed based on the frazier free water protocol with adaptations made to. The presenters hospital, frazier rehab institute in louisville, ky, has successfully managed free water with thousands of dysphagic patients since 1984. Dehydration occurs when you use or lose more fluid than. One of the most common misconceptions is that medicare is a free handout. Previously prohibited, oral intake of water became a major.
Nov 23, 2016 the frazier free water protocol was developed with the aim of providing patients with dysphagia an option to consume thin i. The free water protocol offers a possible solution to the dilemma of keeping our patients safety and health top priority. It allows patients that are on a thicken consistent liquid, drink water. However, i first want to refer you to the frazier free water protocol and the many references that state small amounts of po swallowed will not likely cause respiratory stress. Fluids via intravenously iv fluids via feeding tube. Kathy panther, speech language pathologist, worked closely with pulmonologists to study and implement the frazier water. Free water is not permitted with meals or other oral intake. This document is compiled based on information received from kathy. Once the water has been drained as much as possible, hand the toothette to the patient and ask the patient to clean their mouth. Free water protocol fwp kathy panther, ms cccslp frazier rehab institute, 1984 thin water between meals oral hygiene patientspecific.
A few months ago i was creating a handout on the free water protocol. Previously prohibited, oral intake of water became a major feature in both treatment and day to day hydration. Frazier rehab has implemented water protocol in 1984 water protocol is based on several assumptions. Aspiration of water poses little risk to the patient. Identify guidelines for implementing the frazier free water protocol 3.
If at any time you have questions about the frazier free water protocol, please contact your speechlanguage pathologist. The handout i created had to include the associated risks with adopting the. Therefore, the guidelines for the frazier water protocol will not be posted on this website. Kentuckyone health frazier rehab institute frazier water protocol. Aug 10, 2009 while talked about and used widely, the frazier water protocol developed by panther, or some variation of it, while not published as a research protocol, has been discussed in several articles found on the website and are easy to locate. With limited published research outlining specific protocol guidelines and associated outcomes, facilities. The slp plays a key role in the assessment and intervention for dysphagia management. Patients and caregivers often express concern that longterm orders for thickened liquids or tube feedings without an option for water or ice chips denies a very primitive and basic drive to refresh the senses. Patients follow specific guidelines to decrease the risk of developing aspiration. Family education includes emphasis on the rationale for allowing water intake. A free water protocol fwp is a method sometimes incorporated into dysphagia treatment as a means of increasing hydration and quality of life in a. Effects of a free water protocol for patients with dysphagia. Concern over patient and family noncompliance with thin liquid restrictions both within the facility and after discharge led us to alter our protocol in 1984.
This means brushing all areas of the mouth including tongue, palate, cheeks and sulci. With the free water protocol patients would be able to have the. Pdf the frazier free water protocol semantic scholar. The free water protocol offers a possible solution to the dilemma of keeping our patient s safety and health top priority. Your participation in this survey will be greatly appreciated. University of kentucky department of physical medicine and. The frazier water protocol is part of speech therapy. According to the author of the frazier water protocol, kathy panther 2003. Your doctor has recommended that you be on free water restriction.
Patients exhibiting impulsivity or excessive coughing and discomfort will be restricted to water taken under supervision. It differs from these other protocols in its specification that each participant requires two plans of care pocs as part of the protocol. New directions in dysphagia speechlanguagepathologist. However, no strong evidencebased study has been performed to ensure safety and. There are many important reasons to drink water, especially when working on weight loss. Please do not use the protocol without your therapists permission.
Powered by create your own unique website with customizable templates. To date, the research base for the use of free water protocols is limited. This handout describes the free water protocol, established in 1984 at the frazier rehab institute. Research to determine the impact of a free water protocol on inpatients in a neurological rehabilitation setting is extremely relevant to the patient population at riverview health centre rhc, as many patients at rhc receive a modified diet consisting of thickened liquids. Will not cause a chemical injury as might be expected with other liquids such as coffee, tea, or soda. Please read below a message from the principal investigator of the research from abilene christian university. Use of a modified frazier water protocol in critical illness. Tap water is a clear neutral ph and so it is compatible with other body fluids. For further information, including about cookie settings, please read our cookie policy. Toothbrush manual or electric,toothpaste,oral rinse,floss. Frazier free water protocol npo patients are permitted water any time.
I wanted to make sure i understood the present research, so i read four articles about the free water protocol. Dysphagia and free water protocol in paediatrics childrens health. Therefore, the goal of this proposal is to develop a prospective, randomized and controlled study to determine the safety and efficacy of the frazier free water protocol. A summary of relevant information is detailed below. If the patient has respiratory precautions, then use water minimally, with the semifowler position and with extra precaution. First the pt is given mouth care and than they are allowed to drink water and water is premitted until the first bite of food then the pt goes back to thickened liquid. The handout i created had to include the associated risks with adopting the free water protocol.
Medical speech pathology ceus asha continuing education. Effects of a free water protocol on inpatients in a neuro. Handouts with helpful information on how to cope with stress reactions, worry, anxiety, or other psychological and emotional issues related to diagnosis, illness, injury, surgery, hospitalization, or other medical trauma. Free water protocol in nursing homes john ashford dysphagia. Developed at frazier rehabilitation hospital in louisville, kentucky in 1984 when family and patient noncompliance with thin liquid restrictions became concerning. Sometimes, we feel hungry when we are actually thirsty. The intervention group for whom the free water guidelines were implemented did not differ significantly from the control group in rate of development of aspiration pneumonia, 30.
As expected the research and opinions went both ways. This therapy intervention visual is designed for therapists addressing f and. Implementing oral care to reduce aspiration pneumonia amongst patients with. Implementation of a water protocol in a rehabilitation setting asha. Identify multidisciplines involved in implementation of the free water protocol fun fact. Implementing the free water protocol does not result in. Facts about water the body is approximately 60% water.
Implementation of a water protocol in a rehabilitation setting. Water provides a safe means of assessing patients with thin liquids. Free water protocol speech language pathology why should i follow the free water protocol. Nsw speech pathology evidence based practice interest group. When writing a patient education handout, keep the patient in mind. Implementing a good oral hygiene care program is crucial in dysphagia management because patients who have. The corresponding illustrations provide a visual means of learning to supplement your verbal and written instruction. May 05, 2014 a few months ago i was creating a handout on the free water protocol. Drinking water is important for weight management and overall health.
The free water protocol is not appropriate for all patients. Care facilities its implementation in health free water. Offering patients foods or liquids with noted higher fluid content such as vegetables or pureed vegetables, jello or pudding, and fruits or pureed fruits. Use of a modified frazier water protocol in critical. After several years of a conventional dysphagia program, frazier s swallowing management protocol changed dramatically. Ongoing education of slps on competencies required. Patients exhibiting impulsivity or excessive coughing and discomfort will be restricted to water. All patients who are npo or on a modified diet due to dysphasia can benefit from the frazier water protocol panther does not indicate age restrictions those demonstrating impulsivity or excessive coughing will require supervision of water intake extreme choking may. Ethical and legal implications of the frazier free water protocol. Npo or on thickened liquids to have ice chipswater between meals. Features of frazier s program include the points listed below. Frazier rehab has implemented water protocol in 1984. Hydration is a persistent challenge for patients who are npo.
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