Family education includes emphasis on the rationale for allowing water intake. Frazier water protocol what is the frazier water protocol. 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. Implementing the free water protocol does not result in. If at any time you have questions about the frazier free water protocol, please contact your speechlanguage pathologist. 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. To date, the research base for the use of free water protocols is limited.
Downloadable patient educational materials for kids and parents. This is an informational handout for patients with syndrome of inappropriate antidiuretic hormone siadh. To reduce the risk of thin liquid aspiration, patients are often. 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. Dysphagia patients on thickened fluids or nothing per mouth npo are allowed water between meals. The free water protocol is not appropriate for all patients. What are the stated uses and guidelines of the protocol. To drain press the wet toothette against the glass in a turning motion so that water can be drained out as much as possible. 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. Implementing oral care to reduce aspiration pneumonia amongst patients with. Frazier rehab has implemented water protocol in 1984. It is generally accepted in clinical circles that the decision to allow oral water intake in an aspirating patient requires management of the pneumonia. When writing a patient education handout, keep the patient in mind.
Likewise utilizing the frazier free water protocol, requires good oral care. 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. Download print patient handouts healthcare toolbox. After several years of a conventional dysphagia program, frazier s swallowing management protocol changed dramatically. Medications are not to be taken with water, as pills may be washed into the lungs.
Patients follow specific guidelines to decrease the risk of developing aspiration. Free water protocol speech language pathology why should i follow the free water protocol. Nsw speech pathology evidence based practice interest. The corresponding illustrations provide a visual means of learning to supplement your verbal and written instruction. Frazier free water protocol npo patients are permitted water any time.
Npo or on thickened liquids to have ice chipswater between meals. The water protocol was developed for nonacute patients in rehabilitation, i. This document is compiled based on information received from kathy. Previously prohibited, oral intake of water became a major feature in both treatment and day to day hydration. It differs from these other protocols in its specification that each participant requires two plans of care pocs as part of the protocol. Free water protocol fwp kathy panther, ms cccslp frazier rehab institute, 1984 thin water between meals oral hygiene patientspecific. Implementation of a water protocol in a rehabilitation setting asha. Tap water is a clear neutral ph and so it is compatible with other body fluids. 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. Understanding medicare may actually appropriately begin with an understanding of what medicare is not. Features of frazier s program include the points listed below. An electronic search of the embase, cinahl and medline databases was completed up to july 2016.
For further information, including about cookie settings, please read our cookie policy. Use this worksheet to initiate education with your patients who have copd and dysphagia. 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. One of the most common misconceptions is that medicare is a free handout. With the free water protocol patients would be able to have the. Dehydration occurs when you use or lose more fluid than. Developed at frazier rehabilitation hospital in louisville, kentucky in 1984 when family and patient noncompliance with thin liquid restrictions became concerning. Pdf the frazier free water protocol semantic scholar. Your participation in this survey will be greatly appreciated. A speechlanguage pathologist will determine if a patient is a good candidate for the protocol and will help implement the guidelines. Ethical and legal implications of the frazier free water protocol. Effects of a free water protocol on inpatients in a neuro. Toothbrush manual or electric,toothpaste,oral rinse,floss. Ongoing education of slps on competencies required.
Water provides a safe means of assessing patients with thin liquids. Nsw speech pathology evidence based practice interest group. Identify guidelines for implementing the frazier free water protocol 3. Facts about water the body is approximately 60% water. Semantic scholar extracted view of the frazier free water protocol by kathy. Use of a modified frazier water protocol in critical illness. Free water protocol in nursing homes john ashford dysphagia. Therefore, the guidelines for the frazier water protocol will not be posted on this website. Perspectives on swallowing and swallowing disorders dysphagia 14. Nov 23, 2016 the frazier free water protocol was developed with the aim of providing patients with dysphagia an option to consume thin i. Implementing a good oral hygiene care program is crucial in dysphagia management because patients who have. 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.
Drinking water is important for weight management and overall health. It was developed by kathy panther, ms, cccslp, inpatient rehabilitation director at the frazier rehab institute in louisville, ky 22 years ago. Aspiration of water poses little risk to the patient. The handout describes the risks, benefits, and guidelines around the protocol and is appropriate for staff, patients, families, caregivers, and therapists.
Care facilities its implementation in health free water. 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. This is an informational handout on fluid restrictions for patients with heart disease, including congestive heart failure. Implementation of a water protocol in a rehabilitation setting. The handout i created had to include the associated risks with adopting the.
Free water protocol fwp kathy panther, ms cccslp frazier rehab institute, 1984 thin water between meals oral hygiene patient specific. 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. Patients with extreme coughing or choking during water intake are. According to a study over the span of six years, those who drank at least five glasses of water per day were 41. The free water protocol offers a possible solution to the dilemma of keeping our patients safety and health top priority. The frazier free water protocol is widely administered in the usa and canada. According to the author of the frazier water protocol, kathy panther 2003. There are many important reasons to drink water, especially when working on weight loss. 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.
Hydration is a persistent challenge for patients who are npo. If a drink of water is aspirated, it will be absorbed by the lung mucosal tissues without harm. Fluids via intravenously iv fluids via feeding tube. Features of fraziers program include the points listed below. Dysphagia and free water protocol in paediatrics childrens health. 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. A summary of relevant information is detailed below. It allows patients that are on a thicken consistent liquid, drink water.
Sometimes, we feel hungry when we are actually thirsty. 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. 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. This handout explains what to expect if you are on free water restriction while you are in the hospital. Recent studies have shown that small amounts of water does not.
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. This handout describes the free water protocol, established in 1984 at the frazier rehab institute. The original frazier free water protocol ffwp was developed for the adult stroke. The handout i created had to include the associated risks with adopting the free water protocol. Patients exhibiting impulsivity or excessive coughing and discomfort will be restricted to water. Powered by create your own unique website with customizable templates. Frazier rehab has implemented water protocol in 1984 water protocol is based on several assumptions. However, no strong evidencebased study has been performed to ensure safety and. The frazier free water protocol perspectives on swallowing. 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. Offering patients foods or liquids with noted higher fluid content such as vegetables or pureed vegetables, jello or pudding, and fruits or pureed fruits. The presenters hospital, frazier rehab institute in louisville, ky, has successfully managed free water with thousands of dysphagic patients since 1984. Medical speech pathology ceus asha continuing education. University of kentucky department of physical medicine and.
Please do not use the protocol without your therapists permission. 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. 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. It is neither free, nor is it a the laymans guide to alzheimers disease elderly care tips medicare made easy. As expected the research and opinions went both ways. Free water protocol speech language pathology cleveland. 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. Kentuckyone health frazier rehab institute frazier water protocol. You may drink water after brushing or swabbing your teeth until you take your first bite of food. 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.
Effects of a free water protocol for patients with dysphagia. If the patient has respiratory precautions, then use water minimally, with the semifowler position and with extra precaution. Use simple words, avoid jargon, talk directly to the patient, and explain things as you might to your grandmother or a. The frazier water protocol is part of speech therapy. Once the water has been drained as much as possible, hand the toothette to the patient and ask the patient to clean their mouth. This means brushing all areas of the mouth including tongue, palate, cheeks and sulci. Asha, 2009 exclusion and supervision criteria frazier free water protocol exclusion. Mar 12, 2017 please read below a message from the principal investigator of the research from abilene christian university.
With limited published research outlining specific protocol guidelines and associated outcomes, facilities. 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. 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. The slp plays a key role in the assessment and intervention for dysphagia management. This therapy intervention visual is designed for therapists addressing f and. Mar 25, 2015 what are the stated uses and guidelines of the protocol. Patients who received frazier water protocol were compared to two no.
May 05, 2014 a few months ago i was creating a handout on the free water protocol. 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. Pdf effects of a free water protocol on inpatients in a. Free water is not permitted with meals or other oral intake. Your doctor has recommended that you be on free water restriction. A few months ago i was creating a handout on the free water protocol. The free water protocol offers a possible solution to the dilemma of keeping our patient. Methods the rhc study was a prospective, randomized, controlled pilot study conducted at riverview health centre, in. Dysphagia handout, printable pdf download to easily share information with patients and caregivers. 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. Previously prohibited, oral intake of water became a major. 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. 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. 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. The frazier free water protocol was developed with the aim of providing patients with dysphagia an option to consume thin i. I wanted to make sure i understood the present research, so i read four articles about the free water protocol. No water is allowed during meals or for 30 minutes after meals. Water has a neutral ph, whereas other thin fluids such as coffee, tea, milk or juice do not. Swallowing and swallowing disorders descriptionuse. The free water protocol offers a possible solution to the dilemma of keeping our patient s safety and health top priority. Patients exhibiting impulsivity or excessive coughing and discomfort will be restricted to water taken under supervision.
The frazier water protocol fwp allows residents with dysphagia free access to water with little to no incidence of aspiration pneumonia. New directions in dysphagia speechlanguagepathologist. Will not cause a chemical injury as might be expected with other liquids such as coffee, tea, or soda. Good oral hygiene is a key ingredient of the water protocol. Kathy panther, speech language pathologist, worked closely with pulmonologists to study and implement the frazier water. May 12, 2008 the frazier water protocol is part of speech therapy. Identify multidisciplines involved in implementation of the free water protocol fun fact.