For Providers

1 Page 1 of 2. What Is Free Water Protocol? For Providers The free water protocol allows patients who are NPO or on thickened liquids to have ice chips/ Guidelines water between meals when following specific guidelines. The free water protocol is not appropriate Patient is allowed to drink water between for all patients. A speech language pathologist will meals and 30 minutes after meals. determine if a patient is a good candidate for the Oral care must be done prior to consuming protocol and will help implement the guidelines. water. Research on the water protocol tells us: Patient should sit upright and use appropriate swallowing strategies. Good oral hygiene is a key ingredient of the water protocol. Aspiration of water poses little risk to the patient What are the risks of aspiration? if the oral bacteria associated with aspiration pneumonia are minimized. Aspiration during water-drinking trials was a benign event in most cases (Feinberg, 1990).

2 Water that enters the lungs may be reabsorbed into the bloodstream. The risk of developing aspiration pneumonia is significantly greater if thick liquids or solid foods Allowing a patient free water are aspirated (Holas, DePippo, and Reding, 1994). decreases the risk of dehydration. Patients who aspirated thin liquids did not have increases patient compliance with swallowing a significantly different incidence of aspiration precautions. pneumonia than those who did not aspirate improves patient quality of life. (Feinberg, et al, 1996). continued For informational purposes only. Not to replace the advice of your health care provider. Copyright 2010 Fairview Health Services. All rights reserved. SMART works 521200 REV 01/16. Page 2 of 2. Delayed swallow initiation and excess residue Evidence Base generally occur more often with pureed food than with liquids. Garon, Engle, & Ormiston (1997) showed no difference in aspiration rate between those patients Several factors predict the development of receiving thickened liquids and those on the free aspiration pneumonia: water protocol.

3 Dependence for feeding A chart review was carried out at Frazier rehab Dependence for oral care over 18 months: 234 patients received thickened Decayed teeth liquids on free water protocol. Two of 234 developed Tube feeding aspiration pneumonia; both were suspected of aspirating solid food. Reduced activity level GERD. Panther, Kathy. The Frazier Free Water Protocol.. Swallowing and Swallowing Disorders (Dysphagia), (Langmore, et al, 1998). March 2005; 14: 4 9. If you are deaf or hard of hearing, please let us know. We provide many free services including sign language interpreters, oral interpreters, TTYs, telephone amplifiers, note takers and written materials.