[Dysphagia] lemon glycerine swabs (& my 2 cents)

[sorriso at adelphia.net (sorriso@adelphia.net)]

Does anyone have a copy of the article, "Improving Oral Healthare for the Frail Elderly:  A Review of Widespread Problems of Best Practices?" which appeared in Geriatric Nursing, July/August 2002, vol 23, number 4?  If not that article, anything similar that can be emailed to me?

I am re-addressing the issue of lemon glycerine swabs used for oral care at one of the SNFs I go to.  Nursing are using these on a patient of mine and I asked them to stop.  I need proof to back up this crazy notion of mine.  (They still don't believe me that you don't need a gag reflex to swallow because the pt's MD even said that is so--I heard him!)  I had a fabulous article which specifically addressed the issues of drying mucosa, tooth decay, etc. (I can't recall if it actually was the one above) but I lost or misplaced it.  A search of the archives recommends this study.  A Google search of the internet found me the journal but I'm not paying for it.  

Interestingly enough, the Google search underscored today's controversy on the list.  Look through the citations and you'll see "use lemon glycerine swabs for comfort" and "never use lemon glycerine swabs."  I am firmly in the never use lemon glycerine swabs (for oral care for the sake of this post, I'm not going anywhere near the issue of DPNS right now but okay, since I brought it up, I'm not promoting that either) camp.  I believe that those who are using the swabs to provide comfort are relying on old information which has been proven false (and those disseminating the information haven't kept themselves up-to-date).  How sad that families/caregivers are swabbing the mouths of their loved ones, attempting to provide comfort and are actually causing discomfort by irritating the tissues and likely making them quite thirsty.

I am absolutely positive that it was on this list that I learned the truth about the swabs.  I don't need to have all my information sugar-coated and politically correct.  This is serious stuff we do every day.  If I ever have to stand before a judge to defend what I've done, I'm going to know that it's research proven and I can point to my evidence in a journal.  I'm sure a judge would act authoritatively and speak firmly, professionally; not worry about being "nice."

And, for the record, I did ask a stupid question here once and lived to tell the story and continue asking questions.

I don't blame Irene for being a little fed-up.  It must be incredibly frustrating to be in her position.  She educates us and we don't pay a dime.  Do we respect what is being said more if we pay for it, being lectured in a finite amount of time when we can't ponder what is instructed before questioning, must they be nice?  I spend hundreds of dollars each year for my CEUs and it is here that I really learn.  I think we can all agree that we're all wonderful people with the best of intentions and we'd have a lot of fun over dinner and wine.  But here, I believe we can be all business (it certainly saves on the typing, this is the longest post I've ever had!).

I think Suzanne Morris' ideas on the subject are well worth listening to and it would be a wonderful way for Irene to catalog information and spare herself from repeating it.  The minor glitch would be directing those who need the information to that place.

Since I've taken so much of your time already, let me share another of my experiences today at work.  A registered nurse at another of my SNFs was telling me how well a new patient was doing, "She's swallowing well, you can even see her epiglottis move."  Wow.  

Happy Wednesday and welcome back Irene, I'm one very happy SLP!

Linda A. Zanchi, MA CCC-SLP