[Dysphagia] oral care protocols; thickened liquids during meals?

[gjackson at rochester.rr.com (gerriann jackson)]

Ah, now I see how I got the email from Irene!  I was confused, I opened hers
first.  I will post her response to your email in a sec.
I am still rolling this whole "no thickened" liquids thing around in my
head.  I have just had too many patients who did well on thickened liquids
to give it up entirely yet.  I do have certain individuals that drink free
water between meals after thorough oral care but continue to have thickened
beverages during meals.  These individuals are those with whom there is
clinical evidence of penetraiton/aspiration with thin and who have had a
follow-up video or FEES during which they were sufficiently challenged with
the thickend consistency that I am comfortable about their safety.  I have
not had anyone develop a pneumonia or have problems with hydration with this
regime.  Sometime their status/disease process changes and I change the diet
in response, but so far I have been successful.  This is why my head is
having a hard time wrapping around the "no thickened liquids" idea.    It
makes sense, the evidence is there, but my own anecdotal evidence says
otherwise.

I have discussed this with Irene previously and told her how confused I am.
I feel as if I need to move with caution. I certainly recommend thickend
liquids less, but am hesitant to change diets that are working for patients
and residents.

Gerriann

  -----Original Message-----
  From: Jocelen Gudgeon [mailto:jocelen.gudgeon at gmail.com]
  Sent: Monday, August 27, 2007 11:43 AM
  To: gjackson at rochester.rr.com
  Cc: dysphagia at dysphagia.com
  Subject: oral care protocols; thickened liquids during meals?


  Gerriann and others....

  Would you be willing to share your oral care protocol with others? I want
to update ours as I have been learning so many new things by reading this
listerve and the referenced research articles.

  Also, I'm working towards implementing the "free water" protocol in my
facilities. However, I do have a question about meals: Should you continue
to provide thickened liquids at meal time? I'm learning from Irene
Campbell-Taylor's post's about the increased risk of aspiration
complications with thickened liquids themselves. However, I've heard the
argument that thin liquids given at meal time to someone who is at high risk
for aspirating thin liquids could lead to aspiration of food particles
"caught up in" the thin liquid. Which way do you go?

  Jocelen


  Message: 4
  Date: Sat, 25 Aug 2007 16:41:34 -0400
  From: "gerriann jackson" <gjackson at rochester.rr.com >
  Subject: Re: [Dysphagia] Options as dsphagia specialists
  To: "donna w" <lovdatsoap at gmail.com>
  Cc: dysphagia at b9.com
  Message-ID: < MDEHIFEODKBJKNEJHBDCKEOMCLAA.gjackson at rochester.rr.com>
  Content-Type: text/plain;       charset="UTF-8"

  Donna,
  Your correction does make a difference to the tone of the email.  The skin
care issue is another thing.  I am part of the skin care management team at
my hospital since malutrition and dehydration play important roles in
healing. Out of that participation came a wonderful oral care policy that is
now part of the pathway for anyone with dysphagia or who may be NPO for any
other reason and now that the docs are familiar with the protocol, they ask
for it when they don't like the looks of their patients' oral cavities!!  We
are important to the overall well-being of the patients in our facilities.
In the case of a patient with skin breakdown, if the SLP in question
documented her participation, i.e. swallow abilities, recs for AHN when
necessary, she should not have a problem.

  As for the CFY, she needs supervision, yes?  So it would up to the person
who was supervising her as to how frequent and hands on that supervision
needs to be.  I cannot imagine too many clinical supervisors who would want
to risk their licenses by leaving a clinical fellow without sufficient
supervision in a risky situation.  It is the supervisor who's license is at
risk.

  Gerriann