JCPSLP Vol 20 No 3 November 2018

Patient admission

Prescribe diet and fluids/ strategies (speech)

Swallow assessment (speech)

Mouth care assessment (nursing)

Ongoing dysphagia review (speech)

Mouth cares/oral hygiene (nursing)

Pt on thick fluids?

Instrumental swallow assessment (speech)

Speech review of free water exclusion criteria

Medical clearance (medical)

NO

Is patient suitable for free water

NO

YES

Patient education/ discussion (speech/nursing)

Pt willing for free water?

YES

Documentation of free water; signage; Pt identification (speech)

Commence free water

Pt complications?

Continue free water

NO

Monitoring of temp 3/day for 72 hrs post commencement (nursing)

NO

YES

Related to free water?

Cease free water

YES

Medical review

Figure 3. Free water protocol decision-making framework

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JCPSLP Volume 20, Number 3 2018

Journal of Clinical Practice in Speech-Language Pathology