The idea behind the free water protocol is that water has a neutral ph and is free of bacteria. Medical speech pathology ceus asha continuing education. This protocol identifies patients who are at risk of aspiration on thin fluids. Frazier water protocol nightingale home healthcare. New directions in dysphagia speechlanguagepathologist. Ethical and legal implications of the frazier free water protocol. Free water protocol speech therapy materials, speech. The handout i created had to include the associated risks with adopting the.
Limited information is available regarding use of the frazier free water protocol fwp with hospitalized patients who have dysphagia and have survived a critical illness with compromised pulmonary status. Drinking water is important for weight management and overall health. The frazier free water protocol was developed with the aim of providing patients with dysphagia an option to consume thin i. The frazier water protocol allows patients with dysphagia swallowing problems to drink water that is not thickened, between meals. It allows patients that are on a thicken consistent liquid, drink water. Writing guidelines for afp patient education handouts when writing a patient education handout, keep the patient in mind. Mar 8, 2017 this pin was discovered by galina nisley. A speechlanguage pathologist will determine if a patient is a good candidate for the protocol and will help implement the guidelines. If the patient has respiratory precautions, then use water minimally, with the semifowler position and with extra precaution. Dec 18, 2015 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. Jun 01, 2019 a conference presentation and abstract reporting 2 randomized, controlled pilot studies of patients with stroke n 18 or trauma n 22 assigned to a control group without access to water or ice or to an experimental group with access to water revealed no significant group differences in positive or negative clinical outcomes. The sports medicine patient advisor shinpainshinsplints. Their popularity has blossomed in the nearcomplete absence of any empirical data regarding their safety, effic. The frazier free water protocol ffwp is plain thin water offered between mealtimes and 30 minutes after a meal.
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. Therefore, the guidelines for the frazier water protocol will not be posted on this website. Clients who select this program are required to have teeth brushed prior to ingesting the water or thin liquid and after meals. Family education includes emphasis on the rationale for allowing water intake. The frazier free water protocol was named after frazier hospital. This handout explains why unthickened water is safe for a patient to drink water even if it is aspirated. This handout describes the free water protocol, established in 1984 at the frazier rehab institute. The frazier free water protocol was developed with the aim of providing.
In 1984, frazier hospital began to give all patients unlimited bedside water. They also found that when paired with proper positioning and oral care, there were no incidents of aspiration. May 12, 2008 the frazier water protocol is part of speech therapy. Good oral hygiene is a key ingredient of the water protocol. In 1984, frazier hospital began to give all patients unlimited bedside water andor ice chips. Kentuckyone health frazier rehab institute frazier water protocol. It also identifies specific procedures and conditions that must be followed in order to increase the. It also identifies specific procedures and conditions that. 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 is not appropriate for all patients. Use of a modified frazier water protocol in critical illness. Free water protocol nsw speech pathology ebp network. Jul 2, 2019 hydration is a persistent challenge for patients who are npo. University of kentucky department of physical medicine and. Patients exhibiting impulsivity or excessive coughing and discomfort will be restricted to water. The handout describes the risks, benefits, and guidelines around the protocol and is appropriate for staff, patients, families, caregivers, and therapists. You may drink water after brushing or swabbing your teeth until you take your first bite of food. The free water protocol offers a possible solution to the dilemma of keeping our patient s safety and health top priority. Identify guidelines for implementing the frazier free water protocol 3. Repeat education of guidelines for the fwp to patient. This pilot study used a twogroup nonequivalent comparison group design to evaluate the fwp in. Npo or on thickened liquids to have ice chips water between meals.
Semantic scholar extracted view of the frazier free water protocol by kathy. Patients exhibiting impulsivity or excessive coughing and discomfort will be restricted to water taken under supervision. Per the protocol, patients who are npo or on a dysphagic diet may have water. It was developed by kathy panther, ms, cccslp, inpatient rehabilitation director at the frazier rehab institute in louisville, ky 22 years ago.
The protocol was designed in response to the identification that patients on thickened fluids often consumed less than the recommended. Oral care reduces pneumonia in older patients in nursing. Dec 01, 2011 free water protocols have become common in the management of patients with dysphagia. Free water protocols and its implementation in health care facilities. Tables were created by the first author to extract the key info. Free water protocol speech language pathology cleveland. Free water protocols allow patients who aspirate thin liquids and meet. Frazier rehab has implemented water protocol in 1984 water protocol is based on several assumptions. Implementation and analysis of a free water protocol in. If at any time you have questions about the frazier free water protocol, please contact your speechlanguage pathologist. With the free water protocol patients would be able to have the. To improve oral hydration in patients with dysphagia swallowing problems who must thicken all liquids. Frazier rehab has implemented water protocol in 1984. Identify multidisciplines involved in implementation of the free water protocol fun fact.
Identify guidelines for implementing the frazier free water protocol. Pdf effects of a free water protocol on inpatients in a. Mar 25, 2015 what are the stated uses and guidelines of the protocol. Drink plenty of fluids 8 to 10 glasses of water daily. The presenters hospital, frazier rehab institute in louisville, ky, has successfully managed free water with thousands of dysphagic patients. The slp must obtain a physicians order for the frazier water protocol. The practicing speech pathology members of the adult swallowing ebp group wished to explore the use of the frazier free water protocol with adult patients with dysphagia with in the aim of improving quality of life and fluid intake, whilst minimising pulmonary complications. Download frazier water protocol handout for patients pdf. Frazier free water protocol ffwp and oral health to improve. Use of a modified frazier water protocol in critical. Proactive swallowing therapy while npo in english or espanol. The frazier water protocol allows patients with dysphagia coe. An electronic search of the embase, cinahl and medline databases was completed up to july 2016. Free water protocol fwp kathy panther, ms cccslp frazier rehab institute, 1984 thin water between meals oral hygiene patient specific.
They found that fewer residents had utis and dehydration. A water protocol which allows patients who are npo or on thickened liquid diets have. Implementation and analysis of a free water protocol in acute trauma and stroke patients. Previously prohibited, oral intake of water became a major feature in both treatment and day to day hydration. The presenters hospital, frazier rehab institute in louisville, ky, has successfully managed free water with thousands of dysphagic patients since 1984. Effects of a free water protocol for patients with dysphagia. Hydration is a persistent challenge for patients who are npo. Care facilities its implementation in health free water. Free water protocol speech therapy materials, speech and. Implementing oral care to reduce aspiration pneumonia amongst patients with. Patients with stroke commonly have dysphagia ranging from 47 to 81% depending on the location and severity of stroke. 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. Once the water has been drained as much as possible, hand the toothette to the patient and ask the patient to clean their mouth.
Ethical and legal implications of the frazier free water. To improve oral hydration in patients with dysphagia swallowing problems who must thicken all liquids to make it easier to follow feedingswallowing guidelines with thickened liquids. Water pitchers sometimes end up on tray tables of patients on thick liquids. The frazier free water protocol is widely administered in the usa and canada. Recent research into the effects of dysphagia therapy for patients undergoing head. 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. Speech pathologists on fraziers dysphagia team became concerned by lack. Free water is recommended based on thorough assessment to prioritize patient health. Implementing the free water protocol does not result in. Aspiration of water poses little risk to the patient. Feb 08, 20 the frazier water protocol fwp allows residents with dysphagia free access to water with little to no incidence of aspiration pneumonia.
Add plenty of fiber to diet fruits, vegetables, legumes, and whole grains. 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. Request pdf implementation and analysis of a free water protocol in acute trauma and stroke. The handout describes the risks, benefits, and guidelines around the protocol and is appropriate for staff, patients. This document is compiled based on information received from kathy. Frazier water protocol the protocol rules patients must be assessed by the slp to determine if appropriate for the frazier water protocol. Compressing the injured area decreases the swelling by limiting blood and plasma flow. 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. This handout explains what to expect if you are on free water restriction while you are in the hospital. Dysphagia patients on thickened fluids or nothing per mouth npo are allowed water between meals.
To reduce the risk of thin liquid aspiration, patients are often restricted to. According to a study over the span of six years, those who drank at least five glasses of water per day were 41. Sitting on afirm surface with your injured leg straight in front ofyou. Apply ice for 2030 minutes, for the first 4872 hours, three to four times a day. Water provides a safe means of assessing patients with thin liquids. Implementation and analysis of a free water protocol in acute. No water is allowed during meals or for 30 minutes after meals. The original frazier free water protocol ffwp was developed for the adult stroke population with the aim of providing patients with dysphagia the option to consume thin water in between mealtimes. Your doctor has recommended that you be on free water restriction.
Use simple words, avoid jargon, talk directly to the patient, and explain. Institutionalized elderly patients of the frazier protocol handout as such as can reassure you may increase in nonstroke subjects who your online. Patients, family, staff and caregiver education has to be strong. However, no strong evidencebased study has been performed to ensure safety and. The frazier free water protocol perspectives on swallowing.
There are many important reasons to drink water, especially when working on weight loss. Download frazier water protocol handout for patients doc. To drain press the wet toothette against the glass in a turning motion so that water can be drained out as much as possible. Pdf the frazier free water protocol semantic scholar. 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.
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