Water Protocols: From Theory to Practice
Presented by Jeanette E. Benigas
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Healthcare professionals have utilized water protocols in clinical practice to improve patients' hydration, quality of life, and general health outcomes for over 20 years. However, this approach has received pushback from those who believe that the safer or more conservative option is restricting thin water with a strict requirement for thickened liquids when aspiration is present.
Assessment of risk for respiratory infection and understanding how to minimize that risk are essential steps in successfully using water protocols. This course discusses essential evidence for the use of thin water when aspiration is present, how to minimize the risk of infection, and how to begin to successfully implement a water protocol program in your practice. The learner will hear practical, real-life case examples from speech-language pathologists across settings, including acute care, skilled nursing, and home health, to address how real-life clinicians have overcome the barriers to implementation. Finally, the Ice Chip Protocol is discussed with special guest Susan Langmore, PhD, as a practical first step when facing resistance or for a very ill patient.
Meet your instructor
Jeanette E. Benigas
Jeanette E. Benigas is the owner of Safe Swallowing Diagnostics, a mobile FEES company serving eastern Ohio and western Pennsylvania. Her extensive clinical experience has included work with adults in acute care, inpatient rehabilitation, post-acute rehabilitation, long-term care, home health, and outpatient settings.…
Chapters & learning objectives
1. Foundations
This chapter will provide a brief overview of the history of the Frazier Rehab Institute’s water protocol and several of the most impactful studies supporting the use of thin water for patients who have known aspiration. Familiarity with these studies will help the clinician speak confidently when faced with adversity during the development and implementation of a water protocol.
2. Predictors and Risk for Respiratory Infection
This chapter discusses essential concepts from Dr. Susan Langmore, PhD, CCC-SLP, BCS-S and colleagues, as well as the teachings of Dr. John Ashford, PhD, that help medical practitioners assess the risk for respiratory infection. The ability to assess and predict risk for respiratory infection is a vital skill for clinicians to possess when interested in using water protocols with patients.
3. Oral Care and Aspiration Pneumonia
This chapter presents the idea of considering oral care as oral infection control and the factors that may exacerbate the risk of respiratory infection when the medical team poorly manages oral infection control. Clinicians will also learn about considerations for the development of oral infection control policies and procedures with the interdisciplinary team, which is essential for the success of water protocols and reducing patients' risk.
4. The Frazier Rehab Institute Water Protocol
This chapter discusses the literature that has contributed to the growing body of evidence that water protocols are not harmful to patients with known aspiration. Additionally, the steps and recommendations for the Frazier Rehab Institute’s water protocol are included for consideration by clinicians developing their water protocol programs.
5. Overcoming Barriers
This chapter addresses the barriers identified by clinicians working in the field and presents actual case studies that illustrate how others have overcome such barriers. These case studies will be helpful for clinicians who are experiencing resistance when attempting to implement a water protocol.
6. The Ice Chip Protocol
This chapter presents the Ice Chip Protocol for use during assessment and treatment, including discussion with Dr. Susan Langmore, PhD, CCC-SLP, BCS-S. The use of ice may be more acceptable to resistant administration or care teams. It can also be a good starting point for more impaired patients or those who may not have received anything orally for some time.