ACQ Vol 11 No 1 2009

MULTICULTURALISM AND DYSPHAGIA

Table 2. 2005 Survey of facilities using a free water protocol Facility

Started Modified Notes on participants and Who they

Is it

More

protocol? program

exclude

working? pneumonia?

Frazier Institute for Rehab, Louisville,

1984

Yes, oral Watch chronic lung and immuno-comp people care

Acute

Yes

No

discomfort

Kentucky

carefully; use sips and ice chips in acute care

VAMC, Chillicothe,

1999

No

Need to be cognitively alert, Acute discomfort, Yes

No

Ohio

able to sit, good oral care

poor oral care, non-compliant aspiration on other than thin liquids aspiration; acute discomfort

VAMC, Dayton, Ohio 1999

No

Use with outpatients; COPD Acute patients;

Yes

No

watched carefully

VAMC Cleveland 1998

Yes –

Encourage fluids and push Profuse

Yes

No

Ohio

oral care water; good oral care

St Mary’s Healthcare, 1998 for

Yes sips No straws used on free water; Severe

Yes

No

Grand Rapids,

individuals; and ice if cough on >50% of water

respiratory; bed

Michigan (acute care) formalising chips,

trials then have water via

rest; poor

protocol

water and spoon; have used with some cognition, acute

for facility ice chips, vent patients

discomfort

2004 1998

water Yes, as above

Mary Free Bed Rehab. Grand Rapids,

Strict oral care with “Sage” products. Increases strength, coordination and speeds progression to least restrictive diet; outpatients following protocol as well

As above

Yes

No

Michigan

Paradise Valley Hospital, National City, California

1992

Yes – safe Now use good oral care; liquids calorie counts; will trial diet = no people before excluding

Medical fragility, Yes severe respiratory problems, exclude

No

lipids

very few from water

South Bay Rehab Centre, National City, California Scripps Memorial Hospital, La Jolla,

1992

Yes, as above

Haven’t used thickeners for As above

Yes

No

12 years

1996

Yes, oral Work closely with pulmon-

Severe pulmonary Yes

No

care

ologist; trying ice chips in patients; may ICU with patients with trachs; exclude if non- also use flavoured gloves compliant

California

with water inside and freeze for ICU patients to suck on for oral stim and increased salivation others; hoping to get a 30- person trial sample; using strict oral care; using on a few acute patients per MD referral

Miami Valley Hospital, Dayton,

June 2004 Yes, oral Trialling on Rehab Unit

Samples only so Yes

No

care

patients before expanding to exclusion criteria

Ohio

as with original

protocol

St Boniface General Hospital, Winnipeg, Manitoba, Canada (acute & rehab)

1999

Yes, oral Strict oral care and see if can Medically severe Yes maintain before putting on in ICU, severe care

No

free water. Really watch head/neck cancer patients, respiratory and immuno- compromised patients

discomfort; those who are non- compliant with

protocol

Rehabilitation Hospital of Indiana

March 2001 Yes, oral Oral care critical for success Exclude “super

Yes

No

care

coughers”, advanced PD and brainstem pts

S p eech P athology A ustralia

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