The Frazier Water Protocol (FWP) allows residents with dysphagia free access to water with little to no incidence of aspiration pneumonia. It was developed by Kathy Panther, MS, CCC-SLP, inpatient rehabilitation director at the Frazier Rehab Institute in Louisville, KY 22 years ago.
Recent studies have shown that small amounts of water does not damage a patient’s lungs or lead to increased incidences of pneumonia. Unlike other thin liquids, water has a neutral pH level; therefore, it is well tolerated by the lungs and absorbed quickly into the bloodstream. The discovery of “aquaporins” in the lungs, made by pulmonary physiologist, Richard Effros, MD, supports this premise. The aquaporins act like a sieve. When water enters the alveoli (in the lungs), it is taken up into the blood vessels and carried out to the bloodstream very quickly.
SLP’s delivering dysphagia therapy in long term care have traditionally been focused on preventing aspiration through appropriate modification of diet textures/liquids, compensatory strategies, and strengthening of the oral motor processes involved in the swallow mechanism. There is an increased focus now on preventing dehydration and improving overall quality of life. Nutritional literature indicates that a large segment of our long term care population is at least mildly dehydrated.
Negative results of dehydration; include urinary tract infections (which will impact re-hospitalization for nursing homes this year), constipation, increased confusion, lethargy, acute renal failure, can result in changes in drug potency, decrease wound healing, and have negative impact on the cardiac system. SLP’s are in a unique position to collaborate with the facilities’ nursing team to promote safe implementation of the FWP for residents with swallowing deficits. This will improve hydration and quality of life for the long term care resident.
Key components of the Frazier Water Protocol include:
• Dysphagia residents drink only thickened liquids during meals
• Free water is permitted only between meals
• Nursing should perform a quick check of the oral cavity between meals to make sure no food particles are present prior to offing Free water
• Medications are not to be taken with water as pills may be washed into the lungs
• Patients should utilize compensatory swallow strategies i.e. chin tuck, teaspoon amounts of liquid, etc.
• Exemplary oral care is at all times is a MUST
• Thorough education of all staff is key to success of this program
For more information regarding implementation of the Frazier Free Water Protocol in your facility, please contact Cherie Rowell, Director of Clinical Services for Functional Pathways at crowell@fprehab.com.