ACQ Vol 11 No 1 2009

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38 Sp eech Pathology Australia
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 1984 Yes, oral Watch chronic lung and Acute Yes No
for Rehab, Louisville, care immuno-comp people 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
VAMC, Dayton, Ohio 1999 No Use with outpatients; COPD Acute patients; Yes No
watched carefully aspiration on
other than thin
liquids
VAMC Cleveland 1998 Yes – Encourage fluids and push Profuse Yes No
Ohio oral care water; good oral care aspiration;
acute discomfort
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 water
Mary Free Bed 1998 Yes, as Strict oral care with “Sage” As above Yes No
Rehab. Grand Rapids, above products. Increases strength,
Michigan coordination and speeds
progression to least restrictive
diet; outpatients following
protocol as well
Paradise Valley 1992 Yes – safe Now use good oral care; Medical fragility, Yes No
Hospital, National liquids calorie counts; will trial severe respiratory
City, California diet = no people before excluding problems, exclude
lipids very few from
water
South Bay Rehab 1992 Yes, as Haven’t used thickeners for As above Yes No
Centre, National above 12 years
City, California
Scripps Memorial 1996 Yes, oral Work closely with pulmon- Severe pulmonary Yes No
Hospital, La Jolla, care ologist; trying ice chips in patients; may
California ICU with patients with trachs; exclude if non-
also use flavoured gloves compliant
with water inside and freeze
for ICU patients to suck on for
oral stim and increased
salivation
Miami Valley June 2004 Yes, oral Trialling on Rehab Unit Samples only so Yes No
Hospital, Dayton, care patients before expanding to exclusion criteria
Ohio others; hoping to get a 30- as with original
person trial sample; using protocol
strict oral care; using on a few
acute patients per MD referral
St Boniface General 1999 Yes, oral Strict oral care and see if can Medically severe Yes No
Hospital, Winnipeg, care maintain before putting on in ICU, severe
Manitoba, Canada free water. Really watch discomfort; those
(acute & rehab) head/neck cancer patients, who are non-
respiratory and immuno- compliant with
compromised patients protocol
Rehabilitation March 2001 Yes, oral Oral care critical for success Exclude “super Yes No
Hospital of Indiana care coughers”,
advanced PD and
brainstem pts