Dehydration is a serious condition affecting many patients with dysphagia. Use of thickened liquids only to maintain proper hydration is often inadequate. However, the decision to give free water to dysphagic patients remains controversial, causing many clinicians to be reluctant to offer free water. Just how risky is free water? What is the correlation between free water and aspiration pneumonia? What are the risk factors to monitor when providing free water?
This dynamic e-course will provide answers to these questions by examining the pulmonary literature for effects of water in the lungs. Aspiration pneumonia myths and facts will be addressed. The critical role of oral hygiene will be discussed. The specifics of the Free Water Protocol will be covered in great detail including assessment of which patients can and cannot be managed safely on free water.
The presenter's hospital, Frazier Rehab Institute in Louisville, KY, has successfully managed free water with thousands of dysphagic patients since 1984. What she has learned about aspiration pneumonia, thickened liquids and dehydration will be shared. Participants will gain a new perspective on free water and the knowledge to implement effectively oral hygiene, hydration, and free water protocols in their facilities. Offered for 0.6 CEUs – 6 contact hours.
Run Time: 6:03:19
The content of this online CE course does not focus exclusively on any specific proprietary product or service. Presenter financial and non-financial disclosures may be found in the Presenter & Disclosures area.
Video presentation with downloadable handout. Recorded in front of a live audience in March 2012.
Kathy Panther, MS, CCC-SLP, CBIST, is the Inpatient Rehab Director at Frazier Rehab Institute in Louisville, KY. She is also Director of Frazier's Acquired Brain Injury Program. She has 35 years of experience working in medical rehab. Kathy was one of the first SLPs in the United States to develop and implement a Free Water Protocol. Since 1984, Kathy and her team have successfully managed thousands of dysphagia patients on free water. For the past 25 years, Kathy has educated healthcare professionals on implementing free water protocols, oral care, and hydration management.
Financial — Kathy Panther is an author of online CE courses sponsored by Northern Speech Services; receives royalties.
Financial — Kathy Panther is a presenter of CE seminars sponsored by Northern Speech Services; receives an honorarium.
Nonfinancial — Kathy Panther has no relevant nonfinancial relationships to disclose.
This program is offered for 0.6 ASHA CEUs (Intermediate Level; Professional Area).
ASHA CEUs: NSS online courses are registered with ASHA and are offered for ASHA CEUs. The number of ASHA CEUs is noted above. Note that 0.1 ASHA CEU = 1 contact hour = equals 1 CEE.
ASHA CE Registry: During the enrollment process, if you select to receive ASHA credit for this course and if you provide your ASHA number, NSS will automatically submit your CEU information to the ASHA CE Registry after successful course completion (80% on post test). This submission happens once per month, during the first week of the month. For example, if you complete your course on November 7th, NSS will submit all November online course CEUs to ASHA during the first week of December. When ASHA inputs the information into their database, they will mark the course as completed on the last day of the month in which it was completed, so November 30th using this example. The certificate of completion available for you to print immediately, however, will reflect the actual completion date, November 7th in this example. Due to ASHA processing procedures please allow 2-3 weeks, from the submission date, for the course to appear on your ASHA transcript.
ASHA CEUs: Attendees must meet at least one of the following conditions in order to be eligible to earn ASHA CEUs:
If an attendee is not an ASHA member or CCC holder but meets any of the above criteria, they may inform the ASHA CE Registry of their eligibility by visiting this site.
Licensing Boards: Most state licensing boards DO accept CEUs earned online (usually classified as home-study credits). Some state boards do, however, place a limit to the number of credits that can be earned via home study/online courses. For the most current information, we suggest that you contact your licensing board or agency to verify acceptance policies and/or any credit limits related to home-study courses prior to registering for this course.
Additional accrediting agencies by which Northern Speech is an approved CE provider:
Course Completion Timeframe:
You have unlimited time to complete our online courses. You may log off and log on as often as you’d like to in order to complete all sections of a course.
However, completion dates are based on Eastern Standard Time. Therefore, if you need your CEUs by a certain date, be sure to complete the course test before 11:59pm EST on that date. For example, if you need CEUs before January 1st, you will need to complete the course test before 11:59pm EST on December 31st.
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Certificate of Completion:
On successful completion of the post test (80%), a certificate will be immediately available for download and/or printing. This certificate will include your name, date of completion (based on Eastern Time Zone, USA/Canada), and number of contact hours (CEUs / CEEs). Please note that CEUs are awarded on the date of successful test completion, not the date of course enrollment. Please ensure that you successfully complete the post test prior to any licensure renewal dates.
ASHA CE Registry Submission:
During the enrollment process, if you select to receive ASHA credit for this course and if you provide your ASHA number, NSS will automatically submit your CEU information to the ASHA CE Registry after successful course completion (80% on post test). This submission happens once per month, during the first week of the month. For example, if you complete your course on November 7th, NSS will submit all November online course CEUs to ASHA during the first week of December. When ASHA inputs the information into their database, they will mark the course as completed on the last day of the month in which it was completed, so November 30th using this example. The certificate of completion available for you to print immediately, however, will reflect the actual completion date, November 7th in this example. Due to ASHA processing procedures please allow 2-3 weeks, from the submission date, for the course to appear on your ASHA transcript.
Purchase orders are NOT accepted when registering for online courses. Payment must be made online in the form of a credit or debit card payment.
What is an Online Course?
Our Online Courses consist of video, audio, and/or text content and are offered for ASHA CEUs. Unlike a webinar, which requires participants to be logged on and at a computer at specific times, our Online Courses are available to you at any time, from any device, via your NorthernSpeech.com online account. You may work at your own pace and start and stop your course as you wish. Your course will conclude with a short post test. On successful completion of the post test (>80%), a printable certificate of completion is presented to you.
Northern Speech is an ASHA CE Provider and our online courses are registered with ASHA and offered for ASHA CEUs. Please note that successful completion of the online post test is required prior to the awarding of CEUs. Please contact your state licensing board for acceptance policies related to CEUs earned online.
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You may browse all online courses by clicking the Continuing Education tab above, then Online Courses. Once you find a course, click Enroll Now, and you will be asked to either log into your existing Northern Speech account or create a new online account. Once you’ve entered your account information and provided your credit card payment, your course will be immediately available to you.
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You will be able to access your online course by logging into your Northern Speech account and then clicking the My Online Courses tab on your profile screen. Click the course you would like to start or to resume. From there, proceed through the course sections until you are ready to complete the post test. You do not have to complete your course all at once. You may log on and off as you wish.
Each online course concludes with a post test consisting of multiple choice or true & false questions. Scores of 80% or greater are required for successful course completion and awarding of CEUs. You may revisit course materials and retest as needed to achieve a passing score.
Number of CEUs offered:
We offer courses from 1 to 21 contact hours. Each course will note the number of CEUs offered. Please note that 0.1 CEU = 1 contact hour = 1 CEE.
State licensing boards and online CEUs:
NSS is an ASHA CE Provider and most state licensing boards DO accept ASHA CEUs earned online (usually classified as home-study credits). Some boards do, however, place a limit to the number of CEUs that can be earned via home study/online courses. For the most current information, we suggest that you contact your licensing board or agency to verify acceptance policies and/or any CEU limits related to home-study courses prior to enrolling in an online course.
Our course formats include: text, audio, video, and PowerPoint with author narration. Each course will note the format on the course description page.
Most of our online courses provide a link to download the accompanying handout as a PDF file.
Groups of 3 or more are eligible for a 20% discount on each registration on most of our online courses. To receive this discount, registrations need to be processed together via the "Group Rates" tab on the Online Course of your choice.
For our online courses to function best, we recommend that you update your computer to include the newest version of your Internet browser (Safari, Chrome, Firefox, Edge, Internet Explorer, etc.) and newest version of your computer's operating system. Also a high-speed Internet connection is recommended (cable or DSL). Speakers or headphones will be required for many of our courses as many contain audio components.
Course Cancellation Policy:
A purchased online course can be exchanged, refunded, or transferred to another individual if contact is made with NSS (via phone or email) within 30 days of purchase and the course materials have not been viewed or downloaded.
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“The emphasis on oral care is something I will bring to my daily interactions with nurses and support staff. I liked that the presenter discussed the differences in the field of ST from the time she started until now.” – N.W. (Mar. 2020)
"I found the water protocol and oral care protocols very beneficial to my practice. I've been wanting to implement in my setting but have needed research to go off of. I appreciated all the research provided." – S.S. (Dec. 2019)
"I very much appreciated her permission to use her slides. Great info to be able to use for staff education about Free Water. I enjoyed the suggestions for oral care to support safety of the Frazier Free Water Protocol." – E.B. (Nov. 2019)
"It was very informative. The presenter was very good." – S.C. (Oct. 2019)
"I appreciated going over the correlations between various disease processes and dehydration, xerostoma, and the clear evidence that aspiration alone does not cause PNA. However, I expected step by step instructions for family to help provide oral care." – A.L. (Sept. 2019)
"I liked the comprehensive explanation about the FWP and going over the need for adequate hydration and the importance in recognizing the co-morbid factors that often exacerbate the development of pneumonia." – J.J. (Aug. 2019)
"I appreciated going over the rationale behind the free water protocol. It is important to educate our patients on what the research shows in order to demonstrate how it can be effective." – E.T. (July 2019)
"All information provided was very informative. The presenter was very knowledgeable and able to communicate the information clearly and concisely." – M.C. (June 2019)
"The information was practical. The portion on dysphagia management was most beneficial." – P.K. (May 2019)
"Lots of essential information which will be helpful in explaning the reasoning behind water protocol. I especially enjoyed the theory behind aspiration as well as oral care." – L.B. (Mar. 2019)
"Going over the specifics in how to implement a water protocol was very helpful." – W.W. (Feb. 2019)
"Very practical for everyday practice. All of it was beneficial!" – K.P. (Jan. 2019)
"I liked the overall explanation of oral hygiene practices and Frazier Water Protocol guidelines." – C.R. (Nov. 2018)
"The material was very helpful with my practice especially how to prevent aspiration. All the information on preventing aspiration." – W.N. (Oct. 2018)
"I liked the amount and organization of information. I appreciated the education and evidence of aspiration pneumonia. Good detailed protocol information. There was so much more than I expected." – C.G. (Aug. 2018)
"The course offers good base knowledge on oral care and free water protocols." – K.W. (Jul. 2018)
"The presence of oral pathogens that greatly contribute to aspiration PNA was interesting. I really liked the presenter's demeanor and examples that supported the research/evidence of a free water protocol." L.M. (May 2018)
"The information on dehydration was very informative as I work in an SNF and many of our patients suffer from dehydration. Having the video was very helpful for following along!" – K.C. (May 2018)
"The whole course was very informative and gave a new perspective on how to promote more thin liquids in dysphagia management." – L.A. (May 2018)
"The background research on aspiration pneumonia and the importance of oral hygiene was very helpful." – M.C. (Apr. 2018)
"I like that the course was informative and spent a lot of time focusing on evidence and implementation of specific protocols/programs being discussed." – R.S. (Jan. 2018)
"I appreciated the outline of basic oral care broken down into steps and the review of the risk of dehydration vs aspiration and likelihood that water is a safer liquid to aspirate." – C.J. (Dec. 2017)
"Going over the causes of xerostomia and medication was very helpful - as was the research on modified liquids. I liked the research articles that I can use in order to begin educating nurses and physicians. All courses offered by NSS are excellent." – A.S. (Nov. 2017)
"The discussions on the need for aggressive oral care and the evidence-based research to share with colleagues and physicians were most beneficial." – L.A.K. (Oct. 2017)
"I enjoyed the coverage of aspiration pneumonia and pathogens." – J.B. (July 2017)
"I appreciate that the Frazier Water Protocol is simple and easy to follow. Ms. Panther provides a strong evidence base with the understanding that SLPs may meet resistance from other medical professionals when attempting to implement this practice." – K.M. (June. 2017)
"The discussion on dehydration and viscosity of bolus was very helpful. I liked the handout and the presenter following the handout with additional information!" – C.C. (Jan 2017)
"The detailed information related to dehydration and the xerostomia was most beneficial. I liked that the power points were easy to follow while the speaker was informative and knowledgeable about the content." – J.L. (Dec. 2016)
"I found the new evidence re: increased oral pathogens in CVA patients to be really helpful." – T.A. (Dec. 2016)
"I liked all of the evidence-based research and facts that I can present to my facility to help implement the free water protocol." – D.P. (Dec. 2016)
"I enjoyed the overall topic very much and will be able to apply what I have learned in my every day practice." – K.C. (Dec. 2016)
"I found the discussion on dehydration and oral care to be the most beneficial for my daily practice in SNF. I found this entire course to be very interesting, and I liked that I could listen to each section at my convenience." – C.R. (Nov. 2016)
"I enjoyed the topic related to oral care. I have always said "a healthy mouth is a healthy body." I appreciated the references regarding specific oral care policies and procedures that are in place at different healthcare settings." – H.C. (Oct. 2016)
"The review of the literature provided will help me implement a water protocol for my facility, which frequently relies on thickened liquids with patients who show over signs/symptoms of aspiration. Additionally, this is the first in depth explanation of the implementation of the FWP that I have ever had the chance to participate in. The information provided made it easy to understand." – J.P. (Oct. 2016)
"All of it was beneficial. :) Practical, useful information with evidence based research to back it up." – S.S. (Aug. 2016)
"I especially enjoyed the discussion referring to Oral Care and Free Water in SNF/LTC Facilities. The speaker was interesting and relatable, and the material was relevant." – C.D. (July 2016)
"I really rely on water protocol in my work, and the more research we have to back it up, the better. I found this to be very helpful as a great review and to learn new information. It was great!" – B.C. (June 2016)
"I like that I can now identify patients who will be safe in implementing free water protocol." – K.M. (Apr. 2016)
"The presenter is the best source when it comes to the Free Water Protocol and has a wealth of experience and knowledge on this and oral care programs." – R.A. (Mar. 2016)
"I really appreciated the Frazier protocol outline as well as oral care assessment and administration. There were more topics covered than I expected. All necessary aspects were covered plus some." – T.T. (Feb. 2016)
"All of it was beneficial. I liked the format." – M.G. (Jan. 2016)
"Excellent course." – B.W. (Jan. 2016)