Frazier Rehab Institute (with a "z")

Address:
220 Abraham Flexner Way
Louisville, Ky 40202
(502) 582-7400
Affiliated with Jewish Hospital

"Frazier Rehab Institute has a long tradition of providing quality rehab care for treatment of brain and spinal cord injuries, strokes, amputations, burns, cardiopulmonary conditions, as well as other orthopaedic and neurologic conditions."

From Kentucky Speech-Language Hearing Association Convention, dated March 1, 1996. "New Directions in Dysphagia - Frazier Rehab Center's Water Protocol" by Kathy Panther, MS,CCC.

"After several years of a conventional dysphagia program, Frazier's swallowing management protocol changed dramatically. Concern over patient and family non-compliance with thin liquid restrictions both within the facility and after discharge led us to alter our protocol in 1984. Previously prohibited, oral intake of water became a major feature in both treatment and day to day hydration."

Features of Frazier's program include the points listed below:

SAFETY OF WATER
-Human body is about 60% water. Small amounts of water taken into the lung are quickly absorbed into the body pool.
-Unlike other liquids, water has a neutral pH. Water is free of bacteria and other contaminants and does not contain the chemical compounds found in beverages. Aspiration of other liquids can lead to respiratory infections and pneumonia.
-Water provides a safe means of assessing patients with thin liquids. All patients (of any diagnosis) referred to Speech Pathology are screened for dysphagia with water sips.
-Water is safely utilized in daily treatment of thin liquid restricted patients. Water therapy permits better recognition of patient readiness for repeated videofluoroscopy and diet advancement.

HYDRATION
-Free water consumption is encouraged for all patients and makes a significant contribution in hydration for many.
-The risk and cost of IV fluids should be decreased.
-Post-discharge surveys of Frazier dysphagic patients indicate water often is the primary means of hydration.

FRAZIER REHAB CENTER'S WATER PROTOCOL - WATER BETWEEN MEALS
-By policy, any patient NPO or on a dysphagic diet may have water.
-All patients are screened with water. Patients exhibiting impulsivity or excessive coughing and discomfort will be restricted to water taken under supervision. Patients with extreme choking may not be permitted oral intake of water due to the physical stress of coughing.
-For patients on oral diets, water is permitted between meals. Water intake is unrestricted prior to a meal and allowed 30 minutes after a meal. The period of time following the meal allows spontaneous swallows to clear pooled residues.
-After the screening described above, NPO patients are often permitted water.
-Patients who are thin liquid restricted wear blue bands to communicate the liquid restriction to all staff. Typically, the band reads "No thin liquids except water between meals." All staff are oriented to blue bands and check for bands before offering liquids to patients.
-Water is freely offered to patients throughout the therapy day.
-Medications are never given with water. Pills are given in a spoonful of applesauce, pudding, yogurt, or thickened liquid.
-Family education includes emphasis on the rationale for allowing water intake. The guidelines for water intake are repeated by the Speech Pathologist, Dietitian, and Nurse during the education process.

COMPLIANCE
-Complaints of thirst were frequently voiced prior to 1984. Patients reported thickened liquids did not quench thirst.
-Water eliminates thirst and patient complaints are now much less frequent.
-Many patients and families object to thickened liquids. Since water is an option, patients appear more likely to comply with the thin liquid restriction.
-Once home, preparation of thickened liquids often becomes burdensome. After days or weeks at home the family may tire of patient complaints and abandon thickened liquids.
-Availability and cost of thickening agents and/or prepackaged thick liquids may preclude patient compliance.
-Thick liquid preparation, in addition to other time and energy consuming patient care tasks can overwhelm families."

[We also add meticulous oral hygeine (brush teeth after all meals) to the protocol when using it at ACH.]

See also SLP Chat Archives for a Word doc version.