ACQ Vol 11 No 1 2009

MULTICULTURALISM AND DYSPHAGIA

I n early 2008, clinicians at The Royal Melbourne Hospital (RMH) commenced a quality project to formalise a free water policy (FWP) and collect outcome data. Specifically, we aimed to look at pre and post FWP quality of life (QOL) and medical status measures (including hydration and aspiration related adverse events). The FWP was introduced after obtaining formal clearance from the Ethics Committee at the hospital. Prior to the project, most clinicians at RMH were using the FWP on an ad hoc basis with anecdotally encouraging outcomes. The Free Water Policy is subject to strict criteria at RMH, based on the literature and developed in consultation with respiratory and general medical specialists. They include: n all solids/medicines are taken with thickened fluids; n no active pneumonia/chest infection; n adequate oral hygiene; n sips of water without excessive/uncomfortable coughing/ choking; n supervision for impulsive patients or those who cough excessively; n participant with compromising lung condition to be discussed with registrar or consultant; and n deemed clinically appropriate by the speech pathologist. The quality project collected data on 50 patients from a range of medical and surgical units (including patients considered to be compromised from a respiratory point of view, such as chronic obstructive pulmonary disease, lung capacity and asthma). While not fully analysed to date, preliminary data have shown: Free water policy quality project Kate Mills

n no aspiration related adverse events; n improved QOL/satisfaction scale measures ; n improved overall fluid intake; n improved acceptance of thickened fluids when they are not the sole option. After considering the results more carefully, we plan to write up the results and submit them for publication later in 2009. Kate Mills has been a speech pathologist at the Royal Melbourne Hospital for the last 6 years, with some experience in rehab but the majority in acute. When she started this project Kate was working primarily in General Medicine, Trauma and Respiratory Care, but has since moved into Head & Neck. She has great interest in dysphagia and particularly maximising the quality of life for patients on modified diets. Correspondence to: Kate Mills Speech Pathologist Free Water Policy Project Leader C/o Post Office The Royal Melbourne Hospital Grattan Street Parkville, VIC 3050 email: kate.mills@mh.org.au

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