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Path to Dysphagia Diagnosis
  • Writer's pictureCarinda Stout, MS CCC/SLP

A Deeper Look into the Frazier Free Water Protocol

The Frazier Water Protocol allows patients with dysphagia (swallowing problems) to drink water that is not thickened, between meals.

This handout explains why water that is not thickened is safe for a patient to drink even if it is aspirated. It also identifies specific procedures and conditions that must be followed in order to increase the patient's safety when drinking water.

BUT how can a person with a swallowing disorder drink water without developing pneumonia?

Water has a neutral pH and will therefore not cause chemical injury to the lungs. Our body is made of water so that it is not recognized as a foreign substance. Water is naturally absorbed into the bloodstream without complication as long as it does not carry bacteria or food particles from the mouth. Good oral care prevents bacteria and food particles from entering the lungs. Therefore, if a patient does aspirate water, it will not cause pneumonia.

The proven benefits:

• Decreases the risk of dehydration

• Increases patient compliance with thickened liquids

• Improves the desire to eat

• Increases taste/sensation/saliva production

• Improves oral awareness of food and decreases aspiration

• Increases patient alertness

Patients who benefit:

• At risk for dehydration

• Receiving enteral tube feedings

• Experiencing a dry mouth due to mouth breathing or medication

• Experiencing xerostomia (dry mouth due to lack of saliva)

Patients who do NOT benefit:

• Unable to follow instructions or who are not complaint with the rules of the program

• Dependent, without a reliable family member or caregiver to provide oral care and to follow the rules of the free water program

• Not medically stable

• Unable to drink water without coughing violently

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