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).
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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.
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“Good research supporting aggressive oral care to reduce the risk of aspiration of oral pathogens.” – K.C. (Jun. 2020)
“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 prov
ided 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 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)
"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)
"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)