Implementation of a Free Water Program for Dysphagic Patients in the Acute Rehabilitation Setting
Start Date
5-19-2012 2:00 PM
End Date
5-19-2012 2:15 PM
Description
Swallowing is one of the most complex neuromuscular interactions in the human body. Swallowing problems (dysphagia) may be classified as oropharyngeal or esophageal. Oropharyngeal dysphagia refers to difficulty in the passage of foods and liquids from the mouth to the esophagus. In esophageal dysphagia, there is a disordered passage of food or liquids through the esophagus. The exact incidence of dysphagia is unknown; however, in some epidemiological studies the prevalence is as high as 22% in the population over age 50 and as high as 41% of individuals admitted to the acute rehabilitation setting.
The speech-language pathologist is the interdisciplinary team member responsible for the assessment of dysphagia and the development of the treatment plan. Interventions include diet modification, compensatory strategies and multiple-modality treatments.
Often, when a patient is identified as aspirating “thin” or “regular” liquids, they are subjected to a modified oral diet which includes the use of thickened liquids to compensate for the physiologic deficits resulting in dysphagia. The compliance rate with use of these thickened liquids is often poor. For these patients, dehydration and non-compliance are concerns realized by the entire interdisciplinary team.
The Free Water Program is an evidence-based initiative that was developed via collaboration of the Clinical Nurse Specialist, Nurse Practitioner, Medical Director, Speech-Language Pathologists, Staff Nurses, and Physical and Occupational Therapists on the Comprehensive Acute Rehabilitation Unit at Thomas Jefferson University Hospital.
This poster will focus on the challenges associated with restricting a patient’s oral diet and how, using an evidence-based program, the interdisciplinary team can collaborate to determine the readiness and safety of an individual to participate in the program. Specific aspects of the program will be highlighted: rationale for allowing “free water,” criteria for patient participation, need for supervision vs. independence, role of each interdisciplinary team member in successful execution of the components of the program including the following team members: physician, nurse practitioner, nursing, nursing assistants, speech-language pathologist, physical therapist, occupational therapist, recreational therapist, etc.
Learning Objectives: At the end of this session, participants will:
1. Discuss the rationale for allowing patients with dysphagia, and possible known aspiration risk with “thin” or “regular” liquids, access to free water.
2. Discuss the evidence base available to support use of a free water program with dysphagic patients.
3. Identify the criteria for patients being assigned to a Supervised vs. Independent Free Water Program as established on the Comprehensive Acute Rehabilitation Unit atThomasJeffersonUniversityHospital.
4. Discuss the role of the individual interdisciplinary team members as it pertains to successful participation in the Free Water Program.
Implementation of a Free Water Program for Dysphagic Patients in the Acute Rehabilitation Setting
Swallowing is one of the most complex neuromuscular interactions in the human body. Swallowing problems (dysphagia) may be classified as oropharyngeal or esophageal. Oropharyngeal dysphagia refers to difficulty in the passage of foods and liquids from the mouth to the esophagus. In esophageal dysphagia, there is a disordered passage of food or liquids through the esophagus. The exact incidence of dysphagia is unknown; however, in some epidemiological studies the prevalence is as high as 22% in the population over age 50 and as high as 41% of individuals admitted to the acute rehabilitation setting.
The speech-language pathologist is the interdisciplinary team member responsible for the assessment of dysphagia and the development of the treatment plan. Interventions include diet modification, compensatory strategies and multiple-modality treatments.
Often, when a patient is identified as aspirating “thin” or “regular” liquids, they are subjected to a modified oral diet which includes the use of thickened liquids to compensate for the physiologic deficits resulting in dysphagia. The compliance rate with use of these thickened liquids is often poor. For these patients, dehydration and non-compliance are concerns realized by the entire interdisciplinary team.
The Free Water Program is an evidence-based initiative that was developed via collaboration of the Clinical Nurse Specialist, Nurse Practitioner, Medical Director, Speech-Language Pathologists, Staff Nurses, and Physical and Occupational Therapists on the Comprehensive Acute Rehabilitation Unit at Thomas Jefferson University Hospital.
This poster will focus on the challenges associated with restricting a patient’s oral diet and how, using an evidence-based program, the interdisciplinary team can collaborate to determine the readiness and safety of an individual to participate in the program. Specific aspects of the program will be highlighted: rationale for allowing “free water,” criteria for patient participation, need for supervision vs. independence, role of each interdisciplinary team member in successful execution of the components of the program including the following team members: physician, nurse practitioner, nursing, nursing assistants, speech-language pathologist, physical therapist, occupational therapist, recreational therapist, etc.
Learning Objectives: At the end of this session, participants will:
1. Discuss the rationale for allowing patients with dysphagia, and possible known aspiration risk with “thin” or “regular” liquids, access to free water.
2. Discuss the evidence base available to support use of a free water program with dysphagic patients.
3. Identify the criteria for patients being assigned to a Supervised vs. Independent Free Water Program as established on the Comprehensive Acute Rehabilitation Unit atThomasJeffersonUniversityHospital.
4. Discuss the role of the individual interdisciplinary team members as it pertains to successful participation in the Free Water Program.
