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[DYSPHAGIA] Frazier Water Protocol

At 8:18 AM -0400 07/17/99, MBGerety@aol.com wrote:
>  Do you know where I might find  info about the Frazier Water Protocol?   I
>have made several inquiries  using  Search engines, but so far, no luck.
>Thanks Martha Gerety

For information directly from the Frazier Rehab. Center (in Louisville, KY)
you may call Kathy Panther, Director of Speech Pathology at (502) 582-7483.

The Frazier Water Protocol is summarized below:

"After several years of a conventional dysphagia program, Frazier's
swallowing management protocol changed dramatically.  Concern over
patient and family non-compliance with thin liquid restrictions both
within the facility and after discharge led us to alter our protocol in
1984.  Previously prohibited, oral intake of water became a major
feature in both treatment and day to day hydration.  Features of
Frazier's program include the points listed below.

-Human body is about 60% water.  Small amounts of water taken into the
lung are quickly absorbed into the body pool.
-Unlike other liquids, water has a neutral pH.  Water is free of
bacteria and other contaminants and does not contain the chemical
compounds found in beverages.  Aspiration of other liquids can lead to
respiratory infections and pneumonia.
-Water provides a safe means of assessing patients with thin liquids.
All patients (of any diagnosis) referred to Speech Pathology are
screened for dysphagia with water sips.
-Water is safely utilized in daily treatment of thin liquid restricted
patients.  Water therapy permits better recognition of patient readiness
for repeated videofluoroscopy and diet advancement.

-Free water consumption is encouraged for all patients and makes a
significant contribution in hydration for many.
-The risk and cost of IV fluids should be decreased.
-Post-discharge surveys of Frazier dysphagic patients indicate water
often is the primary means of hydration.

-By policy, any patient NPO or on a dysphagic diet may have water.
-All patients are screened with water.  Patients exhibiting impulsivity
or excessive coughing and discomfort will be restricted to water taken
under supervision.  Patients with extreme choking may not be permitted
oral intake of water due to the physical stress of coughing.
-For patients on oral diets, water is permitted between meals.  Water
intake is unrestricted prior to a meal and allowed 30 minutes after a
meal.  The period of time following the meal allows spontaneous swallows
to clear pooled residues.
-After the screening described above, NPO patients are often permitted
-Patients who are thin liquid restricted wear blue bands to communicate
the liquid restriction to all staff.  Typically, the band reads "No thin
liquids except water between meals."  All staff are oriented to blue
bands and check for bands before offering liquids to patients.
-Water is freely offered to patients throughout the therapy day.
-Medications are never given with water.  Pills are given in a spoonful
of applesauce, pudding, yogurt, or thickened liquid.
-Family education includes emphasis on the rationale for allowing water
intake.  The guidelines for water intake are repeated by the Speech
Pathologist, Dietitian, and Nurse during the education process.

-Complaints of thirst were frequently voiced prior to 1984.  Patients
reported thickened liquids did not quench thirst.  -Water eliminates
thirst and patient complaints are now much less frequent.
-Many patients and families object to thickened liquids.  Since water is
an option, patients appear more likely to comply with the thin liquid
-Once home, preparation of thickened liquids often becomes burdensome.
After days or weeks at home the family may tire of patient complaints
and abandon thickened liquids.
-Availability and cost of thickening agents and/or prepackaged thick
liquids may preclude patient compliance.
-Thick liquid preparation, in addition to other time and energy
consuming patient care tasks can overwhelm families."

Janina Park-Oliver, M.S./CCC-SLP
Speech Language Pathologist
Mountain Land Rehabilitation
Aux. Faculty-University of Utah

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