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[Dysphagia] thickened liquid and the elderly.
It is my understanding that a peroxide rinse is contraindicated because it
will also kill the good bacteria in the mouth. My understanding is that a
50-50 peroxide/water solution should be used to clean dentures and partials
through overnight soaking, but not used as a mouth rinse.
As far as the hydration issue is concerned, some facilities have activities
initiate a group activity where refreshments are part of it and serve water
right away and have people drink it over the course of the event.
It seems to help.
JoAnn
----- Original Message -----
From: "Rehabstaff" <rehabstaff at graceworks.org>
To: <dysphagia at dysphagia.com>
Sent: Thursday, June 14, 2007 1:29 PM
Subject: Re: [Dysphagia] thickened liquid and the elderly.
> I've used the free water protocol with selected geriatric patients for
> about 2 years. Usually they are so excited the first few days to have
> water they drink a lot but then their intake tapers off. We are
> continuing to look at this issue. Patient satisfaction and tolerance of
> thickened liquids has antidotally improved.
>
> I am trying to implement a free water protocol for the entire 49 bed
> rehab unit then hopefully the whole facility (~ 300+ beds in house).
> However, before fully implementing, we are addressing improving oral
> care. I would strongly encourage anyone implementing the free water
> protocol to pay particular attention to oral care - especially using a
> 1.5% peroxide rinse.
>
> Peace,
> Sonja Dragich M.A., CCC-SLP
> Graceworks Lutheran Services
>
> CONFIDENTIALITY NOTICE: The information contained in this email message
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>
>
> -----Original Message-----
> From: dysphagia-request at dysphagia.com
> [mailto:dysphagia-request at dysphagia.com]
> Sent: Thursday, June 14, 2007 7:36 AM
> To: dysphagia at dysphagia.com
> Subject: Dysphagia Digest, Vol 43, Issue 17
>
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> Today's Topics:
>
> 1. training CNA's (Ninon Dovalina)
> 2. Frazier Water protocol screening form (Irene Campbell-Taylor)
> 3. Thickened liquids: Tetrapacs vs on-site thickening
> (Walsh, Linda (R1SE))
> 4. Re: training CNA's (JoAnn Eaton)
> 5. Practice approaches (Irene Campbell-Taylor)
> 6. Re: Practice approaches (Vera Karger)
> 7. Re: Practice approaches (gerriann jackson)
> 8. Re: Practice approaches (Deanna Rolfe)
> 9. Re: Practice approaches (Irene Campbell-Taylor)
>
>
> ----------------------------------------------------------------------
>
> Message: 1
> Date: Wed, 13 Jun 2007 15:02:48 -0700 (PDT)
> From: Ninon Dovalina <ninonslp at yahoo.com>
> Subject: [Dysphagia] training CNA's
> To: Dysphagia at dysphagia.com
> Message-ID: <657796.31977.qm at web55011.mail.re4.yahoo.com>
> Content-Type: text/plain; charset=iso-8859-1
>
> Hello everyone,
>
> I just started working at a SNF and was wondering if anyone has any
> advice on how to best
> train CNA"s and other staff to follow swallow strategies and diet
> recommendations.
> In the short time I have been at this facility, we have been able to
> establish the use of personalized bracelets to alert staff that a person
> is on nectar liquids. That seems to be working out well thus far.
> However, compliance with the rest of recommendations (upright feeding,
> small bites, alternate between solids and liquids,etc) does not seem to
> be working out very well.
>
> Any ideas are appreciated greatly!
>
> Thanks
>
>
>
> ---------------------------------
> Sick sense of humor? Visit Yahoo! TV's Comedy with an Edge to see what's
> on, when.
>
> ------------------------------
>
> Message: 2
> Date: Wed, 13 Jun 2007 15:05:40 -0700 (PDT)
> From: Irene Campbell-Taylor <eripley at yahoo.com>
> Subject: [Dysphagia] Frazier Water protocol screening form
> To: dysphagia at b9.com
> Message-ID: <997920.68622.qm at web30202.mail.mud.yahoo.com>
> Content-Type: text/plain; charset=iso-8859-1
>
> I continue to be amazed at the concern about drinking water and the
> possibility of aspiration. The Frazier hospital has been using this
> approach for, I believe, over 20 years with no problems - or they
> wouldn't still be using it. The most dangerous thing one can aspirate
> mot of the time - barring something that will block the airway or oil,
> acid or large amounts of vomitus - is one's own saliva. It is possible
> to drown in relatively clear water and come to no harm- at 88ml of water
> per kg of body weight required for drowning hypoxia. And, to cap it all,
> until relatively recently, bronchograms were done by deliberately
> injecting barium and water into the lung. How much harm can a few
> mouthfuls of tap water possibly do? There's at least one judge - in
> Montana- who decided that water was just fine for adults with DD in a
> major center and to date, no problems have arisen - over five years. Can
> we just apply known physiology and common sense?
>
>
> Dr I Campbell-Taylor
> Clinical Neuroscientist
> Exclusive Distributor:
> www.interactivetherapy.com
>
> ------------------------------
>
> Message: 3
> Date: Wed, 13 Jun 2007 19:11:40 -0300
> From: "Walsh, Linda \(R1SE\)" <Linda.Walsh at serha.ca>
> Subject: [Dysphagia] Thickened liquids: Tetrapacs vs on-site
> thickening
> To: <dysphagia at dysphagia.com>
> Message-ID: <09957DD31ECEB94FAAD90F6D31FDD433B4229A at RHAEX1.RHA-RRS.CA>
> Content-Type: text/plain; charset="utf-8"
>
> A few years ago we SLPs worked with our Food Services Dept to alter
> their recipes for soups and liquids to make them safer for patients who
> clearly aspirate thin liquids. This was an improvement over the previous
> process of thickening liquids at the bedside, but we find it is still
> inconsistent. We would like to move to using some of the thickened
> liquids available commercially in tetrapacs but our hospital insists it
> will be more expensive. Has anyone done a cost-analysis taking into
> account wastage if products are not acceptable to patients?
>
> Thanks for any info sharing.
>
> Linda
>
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> Merci.
>
> ------------------------------
>
> Message: 4
> Date: Wed, 13 Jun 2007 19:26:29 -0500
> From: "JoAnn Eaton" <joanneaton at charter.net>
> Subject: Re: [Dysphagia] training CNA's
> To: "Ninon Dovalina" <ninonslp at yahoo.com>, <Dysphagia at dysphagia.com>
> Message-ID: <001901c7ae1a$a72faa10$0201a8c0 at CPQ14954210161>
> Content-Type: text/plain; format=flowed; charset="iso-8859-1";
> reply-type=original
>
> Get yourself scheduled for a mandatory in-service. Sometimes the
> facility
> will videotape it for those who can't attend. You develop a handout
> related
> to dysphagia and they can get credit for a one-hour in-service for their
>
> licensing if they take a post-test of a few basic questions. I also
> promise
> treats. . . little do they know.
>
> Experienced, long-empoyed CNAs in the facilities have learned not to sit
>
> close to where I do the in-service because I usually pick someone close
> to
> be my "resident" during the interactive part of the in-service.
> We cover positioning, bite size, etc. in the lecture portion with me
> using
> examples of real residents and explain the "why" of certain
> recommendations.
> Then the fun begins. I've already passed out the juice and cookies or
> rolls,
> etc. Whatever the treat is to be. As I discuss positioning, there will
> be
> one close at hand who is slouched as she listens. So, I bring a clean
> glass
> of water over as I'm moving around the front of the room and say, "This
> is
> why positioning is so important" and grab my "victim" and start giving
> her
> the drink. While I do this, I may talk to the CNA next to her and don't
> look
> directly. If I notice a problem with this in the dining room, I'll even
> start talking to the CNA about someone (made up name NOT on staff)
> getting
> wasted over the weekend or complaining about how someone wasn't helping
> like
> they should. (They get the picture about appropriate communication.)
> Usually
> there is a startle reaction from the person getting the drink. Then I
> ask
> her to describe how she felt about being served in that way. It's a
> great
> opportunity to talk about positioning, mental prepping the resident for
> what's coming, etc. Then I have her sit upright and model the "perfect"
> feeding assistance. After that, all the attendees pair off and practice
> giving food and drink to their partners in good positioning and bad.
> With
> large bites or small. Did I mention that I often use thickener packets
> and
> have them try to thicken the juice?
> This workshop often gets lots of discussion going. I usually run out of
> time. We cover mental set, how to offer choices, ways to reduce
> combative
> behavior by giving choices or letting someone know before they start
> moving
> them what they are doing.
>>From the feedback, this is one of the most popular in-services they
> have.
> (They also like the prizes and real candy treats they get as they
> leave.)
> Good luck!
> JoAnn Eaton
> ----- Original Message -----
> From: "Ninon Dovalina" <ninonslp at yahoo.com>
> To: <Dysphagia at dysphagia.com>
> Sent: Wednesday, June 13, 2007 5:02 PM
> Subject: [Dysphagia] training CNA's
>
>
>> Hello everyone,
>>
>> I just started working at a SNF and was wondering if anyone has any
>> advice on how to best
>> train CNA"s and other staff to follow swallow strategies and diet
>> recommendations.
>> In the short time I have been at this facility, we have been able to
>> establish the use of personalized bracelets to alert staff that a
> person
>> is on nectar liquids. That seems to be working out well thus far.
>> However, compliance with the rest of recommendations (upright feeding,
>
>> small bites, alternate between solids and liquids,etc) does not seem
> to be
>> working out very well.
>>
>> Any ideas are appreciated greatly!
>>
>> Thanks
>>
>>
>>
>> ---------------------------------
>> Sick sense of humor? Visit Yahoo! TV's Comedy with an Edge to see
> what's
>> on, when.
>> _______________________________________________
>> Dysphagia mail list: Normal and disordered swallowing information
>> Dysphagia at dysphagia.com
>> Manage subscription: http://lists.b9.com/mailman/listinfo/dysphagia
>> Visit the new Dysphagia Web Forum: http://dysphagia.com/forum
>>
>
>
>
>
> ------------------------------
>
> Message: 5
> Date: Wed, 13 Jun 2007 18:26:46 -0700 (PDT)
> From: Irene Campbell-Taylor <eripley at yahoo.com>
> Subject: [Dysphagia] Practice approaches
> To: dysphagia at b9.com
> Message-ID: <163275.24898.qm at web30204.mail.mud.yahoo.com>
> Content-Type: text/plain; charset=iso-8859-1
>
> I have the impression from recent posts that few, if any, are paying
> heed to Logemann's findings on the dangers of thickened fluids in the
> elderly in long term care- dehydration, aspiration of thickened liquids
> etc. Why continue with something that has long been known and now proven
> to be dangerous?
>
> Dr I Campbell-Taylor
> Clinical Neuroscientist
> Exclusive Distributor:
> www.interactivetherapy.com
>
> ------------------------------
>
> Message: 6
> Date: Wed, 13 Jun 2007 21:38:41 -0400
> From: Vera Karger <vkargerslp at mac.com>
> Subject: Re: [Dysphagia] Practice approaches
> To: Irene Campbell-Taylor <eripley at yahoo.com>
> Cc: dysphagia at b9.com
> Message-ID: <396F0D1B-318F-4B5F-AEC6-8A57086373E6 at mac.com>
> Content-Type: text/plain; charset=US-ASCII; delsp=yes;
> format=flowed
>
> Irene,
> I'm relieved to be able to return my patients to water. They are as
> well.
> Not having read the study directly, perhaps you can fill me - us - in
> on whether it's suggested that a squeeze of lemon, lime or perhaps
> juice for flavoring may be used? Some patients really dislike plain
> water.
>
> Vera Karger, M.S., CCCS
> Monroe, CT
> vkargerslp at mac.com
>
>
>
> On Jun 13, 2007, at 9:26 PM, Irene Campbell-Taylor wrote:
>
>> I have the impression from recent posts that few, if any, are
>> paying heed to Logemann's findings on the dangers of thickened
>> fluids in the elderly in long term care- dehydration, aspiration of
>> thickened liquids etc. Why continue with something that has long
>> been known and now proven to be dangerous?
>>
>> Dr I Campbell-Taylor
>> Clinical Neuroscientist
>> Exclusive Distributor:
>> www.interactivetherapy.com
>> _______________________________________________
>> Dysphagia mail list: Normal and disordered swallowing information
>> Dysphagia at dysphagia.com
>> Manage subscription: http://lists.b9.com/mailman/listinfo/dysphagia
>> Visit the new Dysphagia Web Forum: http://dysphagia.com/forum
>
>
>
> ------------------------------
>
> Message: 7
> Date: Wed, 13 Jun 2007 21:53:09 -0400
> From: "gerriann jackson" <gjackson at rochester.rr.com>
> Subject: Re: [Dysphagia] Practice approaches
> To: "Vera Karger" <vkargerslp at mac.com>, "Irene Campbell-Taylor"
> <eripley at yahoo.com>
> Cc: dysphagia at b9.com
> Message-ID: <MDEHIFEODKBJKNEJHBDCGEHOCJAA.gjackson at rochester.rr.com>
> Content-Type: text/plain; charset="us-ascii"
>
>
>
> I promote free water between meals, after oral care for my dysphagia
> patients. I cannot, however, ignore the many videos that I have
> performed
> that demonstrate quite clearly a person aspirating on thin and
> tolerating
> thickened liquids. Nor can I ignore the patients who I follow over time
> (LTC attached to hospital) who have experienced relief from chronic
> upper
> respiratory symptoms, including repeated pneumonias after being placed
> on
> thickened liquids.
>
> Research and evidence based practice are important to my practice.
> However,
> there is also evidence and knowledge to be gleaned from every patient
> that I
> treat. Those patients and their outcomes tell me that although probably
> overused, there is an appropriate place for thickened liquids in the LTC
> setting.
>
> Gerriann Jackson
>
> -----Original Message-----
> From: dysphagia-bounces at dysphagia.com
> [mailto:dysphagia-bounces at dysphagia.com]On Behalf Of Vera Karger
> Sent: Wednesday, June 13, 2007 9:39 PM
> To: Irene Campbell-Taylor
> Cc: dysphagia at b9.com
> Subject: Re: [Dysphagia] Practice approaches
>
>
> Irene,
> I'm relieved to be able to return my patients to water. They are as
> well.
> Not having read the study directly, perhaps you can fill me - us - in
> on whether it's suggested that a squeeze of lemon, lime or perhaps
> juice for flavoring may be used? Some patients really dislike plain
> water.
>
> Vera Karger, M.S., CCCS
> Monroe, CT
> vkargerslp at mac.com
>
>
>
> On Jun 13, 2007, at 9:26 PM, Irene Campbell-Taylor wrote:
>
>> I have the impression from recent posts that few, if any, are
>> paying heed to Logemann's findings on the dangers of thickened
>> fluids in the elderly in long term care- dehydration, aspiration of
>> thickened liquids etc. Why continue with something that has long
>> been known and now proven to be dangerous?
>>
>> Dr I Campbell-Taylor
>> Clinical Neuroscientist
>> Exclusive Distributor:
>> www.interactivetherapy.com
>> _______________________________________________
>> Dysphagia mail list: Normal and disordered swallowing information
>> Dysphagia at dysphagia.com
>> Manage subscription: http://lists.b9.com/mailman/listinfo/dysphagia
>> Visit the new Dysphagia Web Forum: http://dysphagia.com/forum
>
> _______________________________________________
> Dysphagia mail list: Normal and disordered swallowing information
> Dysphagia at dysphagia.com
> Manage subscription: http://lists.b9.com/mailman/listinfo/dysphagia
> Visit the new Dysphagia Web Forum: http://dysphagia.com/forum
>
>
>
> ------------------------------
>
> Message: 8
> Date: Thu, 14 Jun 2007 12:56:59 +1000
> From: "Deanna Rolfe" <drolfe at nsccahs.health.nsw.gov.au>
> Subject: Re: [Dysphagia] Practice approaches
> To: "Vera Karger" <vkargerslp at mac.com>, "gerriann jackson"
> <gjackson at rochester.rr.com>, "Irene Campbell-Taylor"
> <eripley at yahoo.com>
> Cc: dysphagia at b9.com
> Message-ID: <46713B1B020000C400005204 at mail.nsccahs.health.nsw.gov.au>
> Content-Type: text/plain; charset=US-ASCII
>
> I have had similar experiences, with some patients who prefer the
> thickened fluids as they find them easier to swallow/control, and stop
> them coughing, or they no longer have respiratory signs.
>
> I have had a number of elderly patients who have been admitted to
> hospital with dehydration, I get asked to see them, find they are
> coughing on fluids and then they refuse to have more after they cough. I
> then try a nectar consistency...no coughing...patient drinks the whole
> cup. These are often patients who don't have the cognitive abilities to
> implement compensatory techniques or therapy.
> I work across both inpatient acute services and outpatients, so I get
> to see people across the spectrum, and often find better outcomes with
> thickened fluids.
>
> So I, too, feel there is a place for them, but agree that they can be
> overused.
>
> Deanna
>
>>>> "gerriann jackson" <gjackson at rochester.rr.com> 14/06/2007 11:53:09
> AM >>>
>
>
> I promote free water between meals, after oral care for my dysphagia
> patients. I cannot, however, ignore the many videos that I have
> performed
> that demonstrate quite clearly a person aspirating on thin and
> tolerating
> thickened liquids. Nor can I ignore the patients who I follow over
> time
> (LTC attached to hospital) who have experienced relief from chronic
> upper
> respiratory symptoms, including repeated pneumonias after being placed
> on
> thickened liquids.
>
> Research and evidence based practice are important to my practice.
> However,
> there is also evidence and knowledge to be gleaned from every patient
> that I
> treat. Those patients and their outcomes tell me that although
> probably
> overused, there is an appropriate place for thickened liquids in the
> LTC
> setting.
>
> Gerriann Jackson
>
> -----Original Message-----
> From: dysphagia-bounces at dysphagia.com
> [mailto:dysphagia-bounces at dysphagia.com]On Behalf Of Vera Karger
> Sent: Wednesday, June 13, 2007 9:39 PM
> To: Irene Campbell-Taylor
> Cc: dysphagia at b9.com
> Subject: Re: [Dysphagia] Practice approaches
>
>
> Irene,
> I'm relieved to be able to return my patients to water. They are as
> well.
> Not having read the study directly, perhaps you can fill me - us - in
> on whether it's suggested that a squeeze of lemon, lime or perhaps
> juice for flavoring may be used? Some patients really dislike plain
> water.
>
> Vera Karger, M.S., CCCS
> Monroe, CT
> vkargerslp at mac.com
>
>
>
> On Jun 13, 2007, at 9:26 PM, Irene Campbell-Taylor wrote:
>
>> I have the impression from recent posts that few, if any, are
>> paying heed to Logemann's findings on the dangers of thickened
>> fluids in the elderly in long term care- dehydration, aspiration of
>> thickened liquids etc. Why continue with something that has long
>> been known and now proven to be dangerous?
>>
>> Dr I Campbell-Taylor
>> Clinical Neuroscientist
>> Exclusive Distributor:
>> www.interactivetherapy.com
>> _______________________________________________
>> Dysphagia mail list: Normal and disordered swallowing information
>> Dysphagia at dysphagia.com
>> Manage subscription: http://lists.b9.com/mailman/listinfo/dysphagia
>> Visit the new Dysphagia Web Forum: http://dysphagia.com/forum
>
> _______________________________________________
> Dysphagia mail list: Normal and disordered swallowing information
> Dysphagia at dysphagia.com
> Manage subscription: http://lists.b9.com/mailman/listinfo/dysphagia
> Visit the new Dysphagia Web Forum: http://dysphagia.com/forum
>
> _______________________________________________
> Dysphagia mail list: Normal and disordered swallowing information
> Dysphagia at dysphagia.com
> Manage subscription: http://lists.b9.com/mailman/listinfo/dysphagia
> Visit the new Dysphagia Web Forum: http://dysphagia.com/forum
>
>
> Disclaimer: This message is intended for the addressee named and may
> contain confidential information. If you are not the intended recipient,
> please delete it and notify the sender. Views expressed in this message
> are those of the individual sender, and are not necessarily the views of
> Northern Sydney Central Coast Health.
> Please note: Northern Sydney Central Coast Health E-Mail addresses have
> changed from @doh.health.nsw.gov.au to @nsccahs.health.nsw.gov.au
> Please make this change in your address books for my contact details.
>
>
>
> ------------------------------
>
> Message: 9
> Date: Thu, 14 Jun 2007 04:35:52 -0700 (PDT)
> From: Irene Campbell-Taylor <eripley at yahoo.com>
> Subject: Re: [Dysphagia] Practice approaches
> To: gerriann jackson <gjackson at rochester.rr.com>, Vera Karger
> <vkargerslp at mac.com>
> Cc: dysphagia at b9.com
> Message-ID: <336339.84110.qm at web30205.mail.mud.yahoo.com>
> Content-Type: text/plain; charset=iso-8859-1
>
>
>
> gerriann jackson <gjackson at rochester.rr.com> wrote:
>
> I promote free water between meals, after oral care for my dysphagia
> patients.
>
> *** Even the best oral care can never remove all pathogens from the
> mouth. I cannot, however, ignore the many videos that I have performed
> that demonstrate quite clearly a person aspirating on thin and
> tolerating
> thickened liquids.
> *** You really must take these findings as what they are- not relevant
> to real life. Logemann in her study on thickeners noted that the VFSS
> did not match the real life situation - it never does.
>
> Nor can I ignore the patients who I follow over time
> (LTC attached to hospital) who have experienced relief from chronic
> upper
> respiratory symptoms, including repeated pneumonias after being placed
> on
> thickened liquids.
> *** But you don't know all of the variables involved. They are,
> undoubtedly, aspirating the thickened liquids as well. See Logemann et
> al. Perhaps, for other reasons, their resistance is better. One cannot
> assume that thickened liquids are not aspirated and we now know for
> certain that they are.
>
> Research and evidence based practice are important to my practice.
> However,
> there is also evidence and knowledge to be gleaned from every patient
> that I
> treat.
> *** Absolutely - but one must also know what changes, biochemical,
> pharmaceutical, immunological, etc. are taking place before reaching
> conclusions based on only one variable.
>
> Those patients and their outcomes tell me that although probably
> overused, there is an appropriate place for thickened liquids in the LTC
> setting.
> *** I, of course, would have to disagree, and, having never used them
> find no reason to suggest that they do have any place - the recent study
> supporting this conclusion.
>
>> Dysphagia mail list: Normal and disordered swallowing information
>> Dysphagia at dysphagia.com
>> Manage subscription: http://lists.b9.com/mailman/listinfo/dysphagia
>> Visit the new Dysphagia Web Forum: http://dysphagia.com/forum
>
> _______________________________________________
> Dysphagia mail list: Normal and disordered swallowing information
> Dysphagia at dysphagia.com
> Manage subscription: http://lists.b9.com/mailman/listinfo/dysphagia
> Visit the new Dysphagia Web Forum: http://dysphagia.com/forum
>
>
>
>
>
> Dr I Campbell-Taylor
> Clinical Neuroscientist
> Exclusive Distributor:
> www.interactivetherapy.com
>
> ------------------------------
>
> _______________________________________________
> Manage subscription: http://lists.b9.com/mailman/listinfo/dysphagia
> Visit the new Dysphagia Web Forum: http://dysphagia.com/forum
>
> End of Dysphagia Digest, Vol 43, Issue 17
> *****************************************
>
> _______________________________________________
> Dysphagia mail list: Normal and disordered swallowing information
> Dysphagia at dysphagia.com
> Manage subscription: http://lists.b9.com/mailman/listinfo/dysphagia
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