Comparison of Outcomes Before and After Implementation of a Water Protocol for Patients With Cerebrovascular Accident and Dysphagia

Frey, Kimberly L.; Ramsberger, Gail

doi:10.1097/jnn.0b013e3182135adf

Cited by 20 publications

(9 citation statements)

References 39 publications

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“…Issues also arise in non-terminally ill patients, for instance where individuals or families decide not to follow recommendations. [97][98][99]169 Careful charting and outcome measurement in such instances helps to further the evidence base around decision making and management. Guideline documents and discussions are available around palliative care and people with dementia.…”

Section: Ethical Considerationsmentioning

confidence: 99%

Dysphagia: implications for older people

Miller

Patterson

2013

Rev. Clin. Gerontol.

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Dysphagia represents a salient concern in many conditions prevalent in older people. There are direct implications for morbidity and mortality. The importance of recognizing and managing dysphagia in hospital and the community also extends to psychosocial impact and quality of life, as well as health, economic and ethical-legal issues. This review outlines reasons for the importance of recognizing and treating dysphagia. It then proceeds to look at recent developments in our understanding of the nature, assessment and management of dysphagia in older people. Whilst there are wellestablished practices in assessment and management, ongoing work continues to challenge the validity and reliability of many methods. These concerns are covered and directions for future developments highlighted.

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Section: Ethical Considerationsmentioning

confidence: 99%

Dysphagia: implications for older people

Miller

Patterson

2013

Rev. Clin. Gerontol.

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“…Free water protocols (FWP) have come into clinical use in an attempt to address some of the detrimental effects of thin fluid restrictions noted above (decreased quality of life, dehydration, and decreased compliance) while still maintaining the safety afforded by the provision of thickened fluids. Although specific details may vary, like the Frazier Free Water Protocol discussed by Panther [6], these protocols allow patients with documented aspiration to consume thin water under specific conditions [19].…”

Section: Introductionmentioning

confidence: 99%

Effects of a Free Water Protocol on Inpatients in a Neuro-Rehabilitation Setting

Pooyania¹,

Vandurme²,

Daun³

et al. 2015

OJTR

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Background: Dysphagia is common among stroke and acquired brain injury (ABI) patients and may result in aspiration. To reduce the risk of thin liquid aspiration, patients are often restricted to thickened fluids. There is considerable clinical interest in the risks and benefits of offering oral water intake, in the form of water protocols, to patients with thin-liquid dysphagia. Objectives: A controlled pilot study of a free water protocol was undertaken at Riverview Health Centre, in Winnipeg, Manitoba to assess benefits, feasibility and possible complications of free water protocol. Methods: The study examined 16 individuals with stroke or ABI who were randomly assigned to either a control group on thickened fluids (six subjects) or a treatment group (ten subjects) that followed a free water protocol. The average length of time in the study was 4.3 weeks with a range of 1-17 weeks among all participants. Results: Throughout the study, there was no incidence of pneumonia in any of the sixteen participants. No statistically significant difference was noted in the weekly total liquid intake between the treatment group and the control group. Perceived swallowing related care results suggest statistically significant improvements from initial to final measures for both the treatment group (p = 0.004) and the control group (p = 0.02). However, a comparison of the change in both measures, between the treatment and control groups, shows no statistically significant differences. Conclusion: This pilot study suggests the need for larger scale work in order to more accurately identify the effects of free water protocols.

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“…This result is consistent with previous research on the FWP in the rehabilitation setting. 1,[20][21][22][23][24][25] Participants in the experimental group showed a trend toward decreased days to discharge from the study, but the small number of participants that were followed precluded statistical testing.…”

Section: Discussionmentioning

confidence: 99%

“…19 To date, 7 studies of the FWP in the rehabilitation setting have been published. 1,[20][21][22][23][24][25] Of these, 6 did not reveal elevated rates of aspiration pneumonia in participants on free water protocols. One study, however, showed lung complications, including aspiration pneumonia, in 6 of 42 participants (14%) randomized to a group with access to water but no lung changes in the control group (n = 34).…”

mentioning

confidence: 99%

Implementation and Analysis of a Free Water Protocol in Acute Trauma and Stroke Patients

Kenedi¹,

Campbell-Vance²,

Reynolds³

et al. 2019

Crit Care Nurse

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Background Free water protocols allow patients who aspirate thin liquids and meet eligibility criteria to have access to water or ice according to specific guidelines. Limited research is available concerning free water protocols in acute care settings. Objectives To compare rates of positive clinical outcomes and negative clinical indicators of a free water protocol in the acute care setting and to continue monitoring participants discharged into the hospital system's rehabilitation setting. Positive clinical outcomes were diet upgrade, fewer days to diet upgrade, and fewer days in the study. Negative clinical indicators were pneumonia, intubation, and diet downgrade. Methods A multidisciplinary team developed and implemented a free water protocol. All eligible stroke and trauma patients (n = 104) treated over a 3-year period were randomly assigned to an experimental group with access to water and ice or a control group without such access. Trained study staff recorded data on positive outcomes and negative indicators; statistical analyses were conducted with blinding. Results No significant group differences in positive outcomes were found (all P values were > .40). Negative clinical indicators were too infrequent to allow for statistical comparison of the 2 groups. Statistical analyses could not be conducted on the small number (n = 15) of patients followed into rehabilitation, but no negative clinical indicators occurred in these patients. Conclusions Larger-scale studies are needed to reach decisive conclusions on the positive outcomes and negative indicators of a free water protocol in the acute care setting. (Critical Care Nurse. 2019;39[3]:e9-e17)

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Comparison of Outcomes Before and After Implementation of a Water Protocol for Patients With Cerebrovascular Accident and Dysphagia

Cited by 20 publications

References 39 publications

Dysphagia: implications for older people

Dysphagia: implications for older people

Effects of a Free Water Protocol on Inpatients in a Neuro-Rehabilitation Setting

Implementation and Analysis of a Free Water Protocol in Acute Trauma and Stroke Patients

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