JCPSLP Vol 20 No 3 November 2018

Limitations and future directions This paper addresses an important evidence–practice gap and aims to provide a purposeful procedure for implementation. Although only pilot data is reported for the oral care protocol regarding the impact of practice change on key stakeholders, the preliminary outcomes support continued use of the MOHAT as a protocol to be used alongside the FWP. Difficulty in recruiting patients to the FWP, however, raises discussion points regarding the utilisation of published inclusion and exclusion criteria in different clinical settings and the safety of making adjustments to previously published protocols. Therefore, research is underway to collect more data, to assess the effectiveness and efficiency of these two protocols and their concurrent implementation, in addition to further discussions relating to the relaxation of the exclusion criteria to facilitate greater patient access to the FWP, while maintaining patient safety. To further determine these protocols’ usability, utility, and clinical outcomes, a number of outcome measures are being collected. These include the rates of compliance with oral care regimes, oral hygiene ratings, time to administer oral care, adverse events (such as aspiration pneumonia), the volume of daily fluid intake, as well as patient and staff satisfaction with the new protocols. In addition, ongoing auditing is taking place of clinical records to determine staff compliance with the two protocols and documentation standards. In line with Grol’s (1997) stepwise and cyclical methodology, outcomes of these evaluations will inform future developments and, always, a collaborative and consultative approach will be taken. Acknowledgements The authors would like to extend their sincere thanks to the Allied Health Professions Office of Queensland for funding to provide a project officer. Many thanks also to Mr Benjamin Tickle (Nursing Clinical Facilitator) and Ms Ursula Mosniegnuer (Nurse Educator) for their instrumental support in training, auditing and supporting the roll out of this model, as well as the entire multidisciplinary team within the Logan Hospital Rehabilitation Unit for their tireless work in making this Andersen, U. T., Beck, A. M., Kjaersgaard, A., Hansen, T., & Poulsen, I. (2013). Systematic review and evidence based recommendations on texture modified foods and thickened fluids for adults ( ≥ 18 years) with oropharyngeal dysphagia. e-SPEN Journal , 8 (4), e127-e134. doi:http://dx.doi. org/10.1016/j.clnme.2013.05.003 Atherton, M., Bellis-Smith, N., Cichero, J., & Suter, M. (2007). Texture-modified foods and thickened fluids as used for individuals with dysphagia: Australian standardised labels and definitions. Nutrition and Dietetics , 64 (2 Supp.), s53–s76. Carlaw, C., Finlayson, H., Beggs, K., Visser, T., Marcoux, C., Coney, D., & Steele, C. M. (2012). Outcomes of a pilot water protocol project in a rehabilitation setting. Dysphagia , 27 (3), 297–306. Chalmers, J., & Johnson, V. (2004). Evidence-based protocol: oral hygiene care for functionally dependent and cognitively impaired older adults. Journal of Gerontological Nursing , 30 (11), 5–9. process possible. References

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JCPSLP Volume 20, Number 3 2018

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