TheraChirps Blog

Frazier Free Water Protocol in your SNF

Frequently I have noted patients being admitted to the SNF with orders for a mechanically altered diet and thickened liquids as well as orders for free water. The Frazier Free Water Protocol developed at the Frazier Rehab Institute allows people with dysphagia access to water with minimal incidence of aspiration pneumonia, as water is tolerated by the lungs and is quickly absorbed into the bloodstream. The incidence and prevalence of dehydration is significant among the long term geriatric population. Allowing free water may facilitate the reduction of dehydration. The Frazier Water Protocol is fairly simple.  Free water is permitted before and between meals. Free water is not permitted with meals or other oral intake. Medications are not to be taken with water, as pills may be washed into the lungs. Implementing a good oral hygiene care program is crucial in dysphagia management because patients who have dental disease and exhibit poor oral care are more likely to develop aspiration pneumonia, regardless of whether they are dependent on others. Likewise utilizing the Frazier Free Water Protocol, requires good oral care. This means brushing all areas of the mouth including tongue, palate, cheeks and sulci.

The SLP plays a key role in the assessment and intervention for dysphagia management; determination of the potential use of free water; education and training of caregivers to ensure carryover of recommendations.

The challenge of using the free water protocol in the Long Term Care SNF is the ability of the caregivers to maintain the exceptional oral care required for safe intake.

Share your experiences with use of the protocol. Have you found it to be successful? Have you been successful in achieving “buy in” from your caregivers?


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