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 epa work assignment manager was brain frazer, and the saic work assignment manager was mary wolfe. A controlled pilot study of a free water protocol was undertaken at riverview. Residential drinking water treatment protocols nsf. Aug 05, 2018 secret tips how to win playing lottery scratch offs how much did i win duration. Fluids via intravenously iv fluids via feeding tube. Nsw speech pathology evidence based practice interest group. The frazier free water protocol was developed with the aim of providing patients with dysphagia an option to consume thin i. There are other concerns you should consider, like the medications you are on. Medical speech pathology ceus asha continuing education. Presented at the asha convention, chicago november 21, 2008. University of kentucky, department of physical medicine and rehabilitation.
May 05, 2014 a few months ago i was creating a handout on the free water protocol. After several years of a conventional dysphagia program, fraziers swallowing management protocol changed dramatically. To set a reading intention, click through to any list item, and look for the panel on the left hand side. Multiple flushing with the syringe will ensure a free flowing system. Have you considered posting a query on ashas interactive member forum on its website.
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. They found that patients receiving thickened liquids failed to meet fluid intake requirements. While on the frazier free water protocol, you can expect the following things. We describe the design and implementation of a water protocol for patients in a rehabilitation setting with videofluoroscopically confirmed thinliquid aspiration. Aug 10, 2009 i am trying to begin a free water protocol at a nursing home i just started working at and am receiving support from the nursing staff and resistance from the lead speech pathologist. Nsw speech pathology evidence based practice interest group critically appraised paper cap clinical bottom line. 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. An electronic search of the embase, cinahl and medline databases was completed up to july 2016. The frazier free water protocol perspectives on swallowing and. The frazier water protocol is part of speech therapy. Frazier rehab has implemented water protocol in 1984. The gf strong water protocol gfswp is an interdisciplinary initiative, with roles and accountabilities specified for different members of the interprofessional healthcare team. After several years of a conventional dysphagia program, frazier s swallowing management protocol changed dramatically.
A summary of relevant information is detailed below. Methods the rhc study was a prospective, randomized, controlled pilot study conducted at riverview health centre, in. 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. Nov 16, 2017 intergovernmental protocol on water resources, water supply and water quality. Dysphagia and free water protocol in paediatrics childrens health. Semantic scholar extracted view of the frazier free water protocol by kathy panther.
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. Castellanos et al 252 random facilities nationally 25,470 residents mean of 8. Frazier rehab has implemented water protocol in 1984 water protocol is based on several assumptions. Water is safely utilized in daily treatment of thin liquid restricted patients. Dysphagia, the frazier water protocol and quality of life 2004 snf prevalence survey. 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 original frazier free water protocol ffwp was developed for the adult stroke population with the aim of providing patients with dysphagia the option to. Water protocol ahs water protocol era university of alberta.
Patients exhibiting impulsivity or excessive coughing and discomfort will be restricted to water taken under supervision. 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 free water protocol can have on a swallowing patients dietary compliance. It includes history, oral motor exam includes cranial. Pdf outcomes of a pilot water protocol project in a. Nsw speech pathology evidence based practice interest. Sep 27, 2010 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. What are the stated uses and guidelines of the protocol.
Ashleigh connell considered implementing a general water protocol that would use the combination of both protocols as researched and presented by caren carlaw 2009. Your nurse will make sure tha t your daily intake of. 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. This file may not be suitable for users of assistive technology. Per the protocol, patients who are npo or on a dysphagic diet may have water. Patients follow specific guidelines to decrease the risk of developing aspiration. Free water protocol the original frazier free water protocol ffwp was developed for the adult stroke population with the.
I wanted to make sure i understood the present research, so i read four articles about the free water protocol. However, no strong evidencebased study has been performed to ensure safety and. She feels that the cnas will not perform this duty properly since they. Water intake is unrestricted prior to a meal, and allowed 30 minutes after a meal. Using the existing protocol for the derivation of water quality guidelines for the protection of aquatic life ccme 1991 as a basis, this revised protocol framework also incorporates new developments in the field of aquatic toxicology. Frazier free water protocol npo patients are permitted water any time. Listing a study does not mean it has been evaluated by the u. New directions in dysphagia speechlanguagepathologist. The free water protocol offers a possible solution to the dilemma of keeping our patients safety and health top priority and adding to the quality of life and satisfaction at the same time. Concern over patient and family noncompliance with thin liquid restrictions both within the facility and after discharge led us to. The free water protocol is not appropriate for all patients. 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.
To date, the research base for the use of free water protocols is limited. Speech pathologists on fraziers dysphagia team became concerned by lack of compliance with patients on thickened liquids diets and resulting dehydration. Implementing the free water protocol does not result in. Intergovernmental protocol on water resources, water supply and water quality.
For some people, this should not be used without working with a medical or naturopathic doctor. Theoretically, patients who consume foods with high water content can. Use of a modified frazier water protocol in critical illness. The frazier water protocol fwp allows residents with dysphagia free access to water with little to no incidence of aspiration pneumonia. The rptb is primarily concerned with drinking water. A speechlanguage pathologist will determine if a patient is a good candidate for the. The slp must obtain a physicians order for the frazier water protocol. Increases family and patient compliance with modified diets and decreases rates of dehydration by allowing. Secret tips how to win playing lottery scratch offs how much did i win duration. This pilot study used a twogroup nonequivalent comparison group design to evaluate the fwp in 15 adults admitted to a respiratory care unit. The effects of a freefluid protocol on individuals with thinliquid dysphagia alyssa schwartzentruber m.
This document is compiled based on information received from kathy. Use of a modified frazier water protocol in critical. But, you may ask for these restricted beverages from your nurse or other unit staff. Patients with stroke commonly have dysphagia ranging from 47 to 81% depending on the location and severity of stroke. Nov 23, 2016 the frazier free water protocol was developed with the aim of providing patients with dysphagia an option to consume thin i. Identify multidisciplines involved in implementation of the free water protocol. Zenkers, microwave hi power, 45 seconds, let stand for 5 minutes. 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. Pdf the frazier free water protocol semantic scholar. For providers the free water protocol allows patients who are npo or on thickened liquids to have ice chipswater between meals when following specific guidelines. The free water protocol was first implemented in 1984 at the frazier rehabilitation. Army, as well as scientists at nsf international, to validate the performance claims of point of use pou drinking water treatment units dwtu to effectively remove all.
Frazier water protocol the protocol rules patients must be assessed by the slp to determine if appropriate for the frazier water protocol. The idea behind the free water protocol is that water has a neutral ph and is free of bacteria. Frazier free water protocol by asha or by special interest division. Care facilities its implementation in health free water. The period of time following the meal allows spontaneous swallows and gravity to clear pooled solid or thickened liquid residues. A randomized controlled trial of a water protocol for clients with thin liquid dysphagia the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. While the planning aspects of this module are targeted at drinking water utilities. A protocol for the derivation of water quality guidelines. Ground water and drinking water, water security division through a contract with saic. This is done with a syringe full of water which is attached directly to the tube.
Mar 12, 2017 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 free water protocol can have on a swallowing patients dietary compliance. Pdf effects of a free water protocol on inpatients in a. Consequently, this revised protocol framework was developed. Water provides a safe means of assessing patients with thin liquids. The handout i created had to include the associated risks with adopting the free water protocol. There are other concerns you should consider, like the medications you are. The frazier free water protocol is widely administered in the usa and canada. Tubes should be flushed with water before and after feeding during intermittent delivery, and every 4 to 8 hours during continuous feeding. A randomized controlled trial of a water protocol for. Npo or on thickened liquids to have ice chipswater between. The frazier free water protocol perspectives on swallowing.
Effects of a free water protocol on inpatients in a neurological rehabilitation setting. Discuss the current state of evidence and limitations for the free water protocol. Recent studies have shown that small amounts of water does not. The protocol on water and health to the 1992 convention on the protection and use of transboundary watercourses and international lakes is the first and only international legal agreement linking sustainable water management and the prevention, control and reduction of. Mar 25, 2015 the conference presented both the frazier water protocol and the gf strong water protocol. It allows patients that are on a thicken consistent liquid, drink water. Previously prohibited, oral intake of water became a major.
All patients of any diagnosis referred to speech pathology are screened for dysphagia with water sips. I am trying to begin a free water protocol at a nursing home i just started working at and am receiving support from the nursing staff and resistance from the lead speech pathologist. Identify guidelines for implementing the frazier free water protocol 3. Og2 dysphagia nova southeastern university july 15, 2010 frazier water protocol 2. Implementation of a water protocol in a rehabilitation setting. 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. Outcomes of a pilot water protocol project in a rehabilitation setting article pdf available in dysphagia 273. Nightingale university nightingale home healthcare. University of kentucky department of physical medicine and. This protocol is a complete form to use for inpt bedside, opt clinical and mbs studies for later reporting. Dehydration occurs when you use or lose more fluid than. Offering patients foods or liquids with noted higher fluid content such as vegetables or pureed vegetables, jello or pudding, and fruits or pureed fruits. When your doctor orders a free water restriction, the hospital kitchen will not send you any beverages from the restricted fluids listed in the table below.
Intergovernmental protocol on water resources, water. Nosocomial legionellosis associated with aspiration of nasogastric feedings diluted in tap water. She feels that the cnas will not perform this duty properly since they 768 ask the expert. May 12, 2008 the frazier water protocol is part of speech therapy. It includes history, oral motor exam includes cranial nerve cross reference, po trials, 3 ounce water test, pulse oximetry measures, penasp and pharyngeal retention scales, checklists of indicators of dysphagia and predictors of. Effects of a free water protocol for patients with dysphagia. You must do mouth care during morning grooming, before and after meals and snacks, before drinking water, and during evening grooming. Responding to drinking water contamination treats and. Sep 18, 2011 we describe the design and implementation of a water protocol for patients in a rehabilitation setting with videofluoroscopically confirmed thinliquid aspiration. The protocol was developed by a team of industry experts, including representatives from jwpa and the u. Frazier rehab centers water protocol water between mealsby policy, any patient npo or on a dysphagic diet may have water.
Procedure card fibrin fraserlendrum method page 1 of 2 control. Implementation of the frasier free water protocol has not been shown to increase the risk of developing aspiration pneumonia in patients with dysphagia. I am not advocating for or against the free water protocol. The frazier free water protocol is widely administered in the usa and.
Overview and application 1 introduction the response protocol tool box rptb is composed of six interrelated modules, in addition to this overview, which focus on different aspects of planning a response to contamination threats and incidents, long before they occur. Effects of a free water protocol on inpatients in a neuro. The search revealed 55 results, 9 of which were relevant to the clinical question. Free water protocol in nursing homes john ashford dysphagia. 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. A randomized controlled trial of a water protocol for clients. Implementing the free water protocol does not result in aspiration pneumonia in carefully selected patients with dysphagia. There will be a purple dot on your wheelchair tag and a sign will be placed on your bedside table to remind all team members. Methods the rhc study was a prospective, randomized, controlled pilot study conducted at riverview health centre, in winnipeg, canada. But there are a few basics to know before you use it. Intergovernmental protocol on water resources, water supply.