|
[Date Prev][Date Next]
[Chronological]
[Thread]
[Top]
[Dysphagia] thickened liquid and the elderly.
- Subject: [Dysphagia] thickened liquid and the elderly.
- From: rehabstaff at graceworks.org (Rehabstaff)
- Date: Thu, 14 Jun 2007 14:29:40 -0400
I've used the free water protocol with selected geriatric patients for
about 2 years. Usually they are so excited the first few days to have
water they drink a lot but then their intake tapers off. We are
continuing to look at this issue. Patient satisfaction and tolerance of
thickened liquids has antidotally improved.
I am trying to implement a free water protocol for the entire 49 bed
rehab unit then hopefully the whole facility (~ 300+ beds in house).
However, before fully implementing, we are addressing improving oral
care. I would strongly encourage anyone implementing the free water
protocol to pay particular attention to oral care - especially using a
1.5% peroxide rinse.
Peace,
Sonja Dragich M.A., CCC-SLP
Graceworks Lutheran Services
CONFIDENTIALITY NOTICE: The information contained in this email message
and in any accompanying documents, may constitute confidential
information. This information is intended only for the use of the
individual or entity named above. If you are not the intended recipient
of this information, you are hereby notified that any disclosure,
copying, distribution or the taking of any action in reliance on this
information is strictly prohibited
-----Original Message-----
From: dysphagia-request at dysphagia.com
[mailto:dysphagia-request at dysphagia.com]
Sent: Thursday, June 14, 2007 7:36 AM
To: dysphagia at dysphagia.com
Subject: Dysphagia Digest, Vol 43, Issue 17
Send Dysphagia mailing list submissions to
dysphagia at dysphagia.com
To subscribe or unsubscribe via the World Wide Web, visit
http://lists.b9.com/mailman/listinfo/dysphagia
or, via email, send a message with subject or body 'help' to
dysphagia-request at dysphagia.com
You can reach the person managing the list at
dysphagia-owner at dysphagia.com
When replying, please edit your Subject line so it is more specific
than "Re: Contents of Dysphagia digest..."
Today's Topics:
1. training CNA's (Ninon Dovalina)
2. Frazier Water protocol screening form (Irene Campbell-Taylor)
3. Thickened liquids: Tetrapacs vs on-site thickening
(Walsh, Linda (R1SE))
4. Re: training CNA's (JoAnn Eaton)
5. Practice approaches (Irene Campbell-Taylor)
6. Re: Practice approaches (Vera Karger)
7. Re: Practice approaches (gerriann jackson)
8. Re: Practice approaches (Deanna Rolfe)
9. Re: Practice approaches (Irene Campbell-Taylor)
----------------------------------------------------------------------
Message: 1
Date: Wed, 13 Jun 2007 15:02:48 -0700 (PDT)
From: Ninon Dovalina <ninonslp at yahoo.com>
Subject: [Dysphagia] training CNA's
To: Dysphagia at dysphagia.com
Message-ID: <657796.31977.qm at web55011.mail.re4.yahoo.com>
Content-Type: text/plain; charset=iso-8859-1
Hello everyone,
I just started working at a SNF and was wondering if anyone has any
advice on how to best
train CNA"s and other staff to follow swallow strategies and diet
recommendations.
In the short time I have been at this facility, we have been able to
establish the use of personalized bracelets to alert staff that a person
is on nectar liquids. That seems to be working out well thus far.
However, compliance with the rest of recommendations (upright feeding,
small bites, alternate between solids and liquids,etc) does not seem to
be working out very well.
Any ideas are appreciated greatly!
Thanks
---------------------------------
Sick sense of humor? Visit Yahoo! TV's Comedy with an Edge to see what's
on, when.
------------------------------
Message: 2
Date: Wed, 13 Jun 2007 15:05:40 -0700 (PDT)
From: Irene Campbell-Taylor <eripley at yahoo.com>
Subject: [Dysphagia] Frazier Water protocol screening form
To: dysphagia at b9.com
Message-ID: <997920.68622.qm at web30202.mail.mud.yahoo.com>
Content-Type: text/plain; charset=iso-8859-1
I continue to be amazed at the concern about drinking water and the
possibility of aspiration. The Frazier hospital has been using this
approach for, I believe, over 20 years with no problems - or they
wouldn't still be using it. The most dangerous thing one can aspirate
mot of the time - barring something that will block the airway or oil,
acid or large amounts of vomitus - is one's own saliva. It is possible
to drown in relatively clear water and come to no harm- at 88ml of water
per kg of body weight required for drowning hypoxia. And, to cap it all,
until relatively recently, bronchograms were done by deliberately
injecting barium and water into the lung. How much harm can a few
mouthfuls of tap water possibly do? There's at least one judge - in
Montana- who decided that water was just fine for adults with DD in a
major center and to date, no problems have arisen - over five years. Can
we just apply known physiology and common sense?
Dr I Campbell-Taylor
Clinical Neuroscientist
Exclusive Distributor:
www.interactivetherapy.com
------------------------------
Message: 3
Date: Wed, 13 Jun 2007 19:11:40 -0300
From: "Walsh, Linda \(R1SE\)" <Linda.Walsh at serha.ca>
Subject: [Dysphagia] Thickened liquids: Tetrapacs vs on-site
thickening
To: <dysphagia at dysphagia.com>
Message-ID: <09957DD31ECEB94FAAD90F6D31FDD433B4229A at RHAEX1.RHA-RRS.CA>
Content-Type: text/plain; charset="utf-8"
A few years ago we SLPs worked with our Food Services Dept to alter
their recipes for soups and liquids to make them safer for patients who
clearly aspirate thin liquids. This was an improvement over the previous
process of thickening liquids at the bedside, but we find it is still
inconsistent. We would like to move to using some of the thickened
liquids available commercially in tetrapacs but our hospital insists it
will be more expensive. Has anyone done a cost-analysis taking into
account wastage if products are not acceptable to patients?
Thanks for any info sharing.
Linda
----- SERHA Disclaimer -----
This electronic transmission and any accompanying attachments may
contain priviledged
or confidential information intended only for the use of the individual
or organization
named above. Any distribution, copying or action taken in reliance on
the contents of
this communication by anyone other than the intended recipient(s) is
STRICTLY PROHIBITED.
If you have received this communication in error please notify the
sender at the above
e-mail address and delete this e-mail immediately.
Thank you.
Cette communication ?lectronique et toute pi?ce jointe peuvent contenir
de l'information
de nature privil?gi?e ou confidentielle et sont strictement r?serv?es ?
l'usage du
destinataire vis? et identifi? ci-dessus. Si vous n'?tes pas le
destinataire vis?, prenez
avis que toute distribution, reproduction ou mesure fond?e sur
l'information qui y est
contenue est EXPRESS?MENT INTERDITE.
Si vous avez re?u cette communication par erreur, veuillez en aviser
imm?diatement
l'exp?diteur par courriel (? l'adresse ?lectronique mentionn?e
ci-dessus) et supprimer le
message d'origine.
Merci.
------------------------------
Message: 4
Date: Wed, 13 Jun 2007 19:26:29 -0500
From: "JoAnn Eaton" <joanneaton at charter.net>
Subject: Re: [Dysphagia] training CNA's
To: "Ninon Dovalina" <ninonslp at yahoo.com>, <Dysphagia at dysphagia.com>
Message-ID: <001901c7ae1a$a72faa10$0201a8c0 at CPQ14954210161>
Content-Type: text/plain; format=flowed; charset="iso-8859-1";
reply-type=original
Get yourself scheduled for a mandatory in-service. Sometimes the
facility
will videotape it for those who can't attend. You develop a handout
related
to dysphagia and they can get credit for a one-hour in-service for their
licensing if they take a post-test of a few basic questions. I also
promise
treats. . . little do they know.
Experienced, long-empoyed CNAs in the facilities have learned not to sit
close to where I do the in-service because I usually pick someone close
to
be my "resident" during the interactive part of the in-service.
We cover positioning, bite size, etc. in the lecture portion with me
using
examples of real residents and explain the "why" of certain
recommendations.
Then the fun begins. I've already passed out the juice and cookies or
rolls,
etc. Whatever the treat is to be. As I discuss positioning, there will
be
one close at hand who is slouched as she listens. So, I bring a clean
glass
of water over as I'm moving around the front of the room and say, "This
is
why positioning is so important" and grab my "victim" and start giving
her
the drink. While I do this, I may talk to the CNA next to her and don't
look
directly. If I notice a problem with this in the dining room, I'll even
start talking to the CNA about someone (made up name NOT on staff)
getting
wasted over the weekend or complaining about how someone wasn't helping
like
they should. (They get the picture about appropriate communication.)
Usually
there is a startle reaction from the person getting the drink. Then I
ask
her to describe how she felt about being served in that way. It's a
great
opportunity to talk about positioning, mental prepping the resident for
what's coming, etc. Then I have her sit upright and model the "perfect"
feeding assistance. After that, all the attendees pair off and practice
giving food and drink to their partners in good positioning and bad.
With
large bites or small. Did I mention that I often use thickener packets
and
have them try to thicken the juice?
This workshop often gets lots of discussion going. I usually run out of
time. We cover mental set, how to offer choices, ways to reduce
combative
behavior by giving choices or letting someone know before they start
moving
them what they are doing.
>From the feedback, this is one of the most popular in-services they
have.
(They also like the prizes and real candy treats they get as they
leave.)
Good luck!
JoAnn Eaton
----- Original Message -----
From: "Ninon Dovalina" <ninonslp at yahoo.com>
To: <Dysphagia at dysphagia.com>
Sent: Wednesday, June 13, 2007 5:02 PM
Subject: [Dysphagia] training CNA's
> Hello everyone,
>
> I just started working at a SNF and was wondering if anyone has any
> advice on how to best
> train CNA"s and other staff to follow swallow strategies and diet
> recommendations.
> In the short time I have been at this facility, we have been able to
> establish the use of personalized bracelets to alert staff that a
person
> is on nectar liquids. That seems to be working out well thus far.
> However, compliance with the rest of recommendations (upright feeding,
> small bites, alternate between solids and liquids,etc) does not seem
to be
> working out very well.
>
> Any ideas are appreciated greatly!
>
> Thanks
>
>
>
> ---------------------------------
> Sick sense of humor? Visit Yahoo! TV's Comedy with an Edge to see
what's
> on, when.
> _______________________________________________
> Dysphagia mail list: Normal and disordered swallowing information
> Dysphagia at dysphagia.com
> Manage subscription: http://lists.b9.com/mailman/listinfo/dysphagia
> Visit the new Dysphagia Web Forum: http://dysphagia.com/forum
>
------------------------------
Message: 5
Date: Wed, 13 Jun 2007 18:26:46 -0700 (PDT)
From: Irene Campbell-Taylor <eripley at yahoo.com>
Subject: [Dysphagia] Practice approaches
To: dysphagia at b9.com
Message-ID: <163275.24898.qm at web30204.mail.mud.yahoo.com>
Content-Type: text/plain; charset=iso-8859-1
I have the impression from recent posts that few, if any, are paying
heed to Logemann's findings on the dangers of thickened fluids in the
elderly in long term care- dehydration, aspiration of thickened liquids
etc. Why continue with something that has long been known and now proven
to be dangerous?
Dr I Campbell-Taylor
Clinical Neuroscientist
Exclusive Distributor:
www.interactivetherapy.com
------------------------------
Message: 6
Date: Wed, 13 Jun 2007 21:38:41 -0400
From: Vera Karger <vkargerslp at mac.com>
Subject: Re: [Dysphagia] Practice approaches
To: Irene Campbell-Taylor <eripley at yahoo.com>
Cc: dysphagia at b9.com
Message-ID: <396F0D1B-318F-4B5F-AEC6-8A57086373E6 at mac.com>
Content-Type: text/plain; charset=US-ASCII; delsp=yes;
format=flowed
Irene,
I'm relieved to be able to return my patients to water. They are as
well.
Not having read the study directly, perhaps you can fill me - us - in
on whether it's suggested that a squeeze of lemon, lime or perhaps
juice for flavoring may be used? Some patients really dislike plain
water.
Vera Karger, M.S., CCCS
Monroe, CT
vkargerslp at mac.com
On Jun 13, 2007, at 9:26 PM, Irene Campbell-Taylor wrote:
> I have the impression from recent posts that few, if any, are
> paying heed to Logemann's findings on the dangers of thickened
> fluids in the elderly in long term care- dehydration, aspiration of
> thickened liquids etc. Why continue with something that has long
> been known and now proven to be dangerous?
>
> Dr I Campbell-Taylor
> Clinical Neuroscientist
> Exclusive Distributor:
> www.interactivetherapy.com
> _______________________________________________
> Dysphagia mail list: Normal and disordered swallowing information
> Dysphagia at dysphagia.com
> Manage subscription: http://lists.b9.com/mailman/listinfo/dysphagia
> Visit the new Dysphagia Web Forum: http://dysphagia.com/forum
------------------------------
Message: 7
Date: Wed, 13 Jun 2007 21:53:09 -0400
From: "gerriann jackson" <gjackson at rochester.rr.com>
Subject: Re: [Dysphagia] Practice approaches
To: "Vera Karger" <vkargerslp at mac.com>, "Irene Campbell-Taylor"
<eripley at yahoo.com>
Cc: dysphagia at b9.com
Message-ID: <MDEHIFEODKBJKNEJHBDCGEHOCJAA.gjackson at rochester.rr.com>
Content-Type: text/plain; charset="us-ascii"
I promote free water between meals, after oral care for my dysphagia
patients. I cannot, however, ignore the many videos that I have
performed
that demonstrate quite clearly a person aspirating on thin and
tolerating
thickened liquids. Nor can I ignore the patients who I follow over time
(LTC attached to hospital) who have experienced relief from chronic
upper
respiratory symptoms, including repeated pneumonias after being placed
on
thickened liquids.
Research and evidence based practice are important to my practice.
However,
there is also evidence and knowledge to be gleaned from every patient
that I
treat. Those patients and their outcomes tell me that although probably
overused, there is an appropriate place for thickened liquids in the LTC
setting.
Gerriann Jackson
-----Original Message-----
From: dysphagia-bounces at dysphagia.com
[mailto:dysphagia-bounces at dysphagia.com]On Behalf Of Vera Karger
Sent: Wednesday, June 13, 2007 9:39 PM
To: Irene Campbell-Taylor
Cc: dysphagia at b9.com
Subject: Re: [Dysphagia] Practice approaches
Irene,
I'm relieved to be able to return my patients to water. They are as
well.
Not having read the study directly, perhaps you can fill me - us - in
on whether it's suggested that a squeeze of lemon, lime or perhaps
juice for flavoring may be used? Some patients really dislike plain
water.
Vera Karger, M.S., CCCS
Monroe, CT
vkargerslp at mac.com
On Jun 13, 2007, at 9:26 PM, Irene Campbell-Taylor wrote:
> I have the impression from recent posts that few, if any, are
> paying heed to Logemann's findings on the dangers of thickened
> fluids in the elderly in long term care- dehydration, aspiration of
> thickened liquids etc. Why continue with something that has long
> been known and now proven to be dangerous?
>
> Dr I Campbell-Taylor
> Clinical Neuroscientist
> Exclusive Distributor:
> www.interactivetherapy.com
> _______________________________________________
> Dysphagia mail list: Normal and disordered swallowing information
> Dysphagia at dysphagia.com
> Manage subscription: http://lists.b9.com/mailman/listinfo/dysphagia
> Visit the new Dysphagia Web Forum: http://dysphagia.com/forum
_______________________________________________
Dysphagia mail list: Normal and disordered swallowing information
Dysphagia at dysphagia.com
Manage subscription: http://lists.b9.com/mailman/listinfo/dysphagia
Visit the new Dysphagia Web Forum: http://dysphagia.com/forum
------------------------------
Message: 8
Date: Thu, 14 Jun 2007 12:56:59 +1000
From: "Deanna Rolfe" <drolfe at nsccahs.health.nsw.gov.au>
Subject: Re: [Dysphagia] Practice approaches
To: "Vera Karger" <vkargerslp at mac.com>, "gerriann jackson"
<gjackson at rochester.rr.com>, "Irene Campbell-Taylor"
<eripley at yahoo.com>
Cc: dysphagia at b9.com
Message-ID: <46713B1B020000C400005204 at mail.nsccahs.health.nsw.gov.au>
Content-Type: text/plain; charset=US-ASCII
I have had similar experiences, with some patients who prefer the
thickened fluids as they find them easier to swallow/control, and stop
them coughing, or they no longer have respiratory signs.
I have had a number of elderly patients who have been admitted to
hospital with dehydration, I get asked to see them, find they are
coughing on fluids and then they refuse to have more after they cough. I
then try a nectar consistency...no coughing...patient drinks the whole
cup. These are often patients who don't have the cognitive abilities to
implement compensatory techniques or therapy.
I work across both inpatient acute services and outpatients, so I get
to see people across the spectrum, and often find better outcomes with
thickened fluids.
So I, too, feel there is a place for them, but agree that they can be
overused.
Deanna
>>> "gerriann jackson" <gjackson at rochester.rr.com> 14/06/2007 11:53:09
AM >>>
I promote free water between meals, after oral care for my dysphagia
patients. I cannot, however, ignore the many videos that I have
performed
that demonstrate quite clearly a person aspirating on thin and
tolerating
thickened liquids. Nor can I ignore the patients who I follow over
time
(LTC attached to hospital) who have experienced relief from chronic
upper
respiratory symptoms, including repeated pneumonias after being placed
on
thickened liquids.
Research and evidence based practice are important to my practice.
However,
there is also evidence and knowledge to be gleaned from every patient
that I
treat. Those patients and their outcomes tell me that although
probably
overused, there is an appropriate place for thickened liquids in the
LTC
setting.
Gerriann Jackson
-----Original Message-----
From: dysphagia-bounces at dysphagia.com
[mailto:dysphagia-bounces at dysphagia.com]On Behalf Of Vera Karger
Sent: Wednesday, June 13, 2007 9:39 PM
To: Irene Campbell-Taylor
Cc: dysphagia at b9.com
Subject: Re: [Dysphagia] Practice approaches
Irene,
I'm relieved to be able to return my patients to water. They are as
well.
Not having read the study directly, perhaps you can fill me - us - in
on whether it's suggested that a squeeze of lemon, lime or perhaps
juice for flavoring may be used? Some patients really dislike plain
water.
Vera Karger, M.S., CCCS
Monroe, CT
vkargerslp at mac.com
On Jun 13, 2007, at 9:26 PM, Irene Campbell-Taylor wrote:
> I have the impression from recent posts that few, if any, are
> paying heed to Logemann's findings on the dangers of thickened
> fluids in the elderly in long term care- dehydration, aspiration of
> thickened liquids etc. Why continue with something that has long
> been known and now proven to be dangerous?
>
> Dr I Campbell-Taylor
> Clinical Neuroscientist
> Exclusive Distributor:
> www.interactivetherapy.com
> _______________________________________________
> Dysphagia mail list: Normal and disordered swallowing information
> Dysphagia at dysphagia.com
> Manage subscription: http://lists.b9.com/mailman/listinfo/dysphagia
> Visit the new Dysphagia Web Forum: http://dysphagia.com/forum
_______________________________________________
Dysphagia mail list: Normal and disordered swallowing information
Dysphagia at dysphagia.com
Manage subscription: http://lists.b9.com/mailman/listinfo/dysphagia
Visit the new Dysphagia Web Forum: http://dysphagia.com/forum
_______________________________________________
Dysphagia mail list: Normal and disordered swallowing information
Dysphagia at dysphagia.com
Manage subscription: http://lists.b9.com/mailman/listinfo/dysphagia
Visit the new Dysphagia Web Forum: http://dysphagia.com/forum
Disclaimer: This message is intended for the addressee named and may
contain confidential information. If you are not the intended recipient,
please delete it and notify the sender. Views expressed in this message
are those of the individual sender, and are not necessarily the views of
Northern Sydney Central Coast Health.
Please note: Northern Sydney Central Coast Health E-Mail addresses have
changed from @doh.health.nsw.gov.au to @nsccahs.health.nsw.gov.au
Please make this change in your address books for my contact details.
------------------------------
Message: 9
Date: Thu, 14 Jun 2007 04:35:52 -0700 (PDT)
From: Irene Campbell-Taylor <eripley at yahoo.com>
Subject: Re: [Dysphagia] Practice approaches
To: gerriann jackson <gjackson at rochester.rr.com>, Vera Karger
<vkargerslp at mac.com>
Cc: dysphagia at b9.com
Message-ID: <336339.84110.qm at web30205.mail.mud.yahoo.com>
Content-Type: text/plain; charset=iso-8859-1
gerriann jackson <gjackson at rochester.rr.com> wrote:
I promote free water between meals, after oral care for my dysphagia
patients.
*** Even the best oral care can never remove all pathogens from the
mouth. I cannot, however, ignore the many videos that I have performed
that demonstrate quite clearly a person aspirating on thin and
tolerating
thickened liquids.
*** You really must take these findings as what they are- not relevant
to real life. Logemann in her study on thickeners noted that the VFSS
did not match the real life situation - it never does.
Nor can I ignore the patients who I follow over time
(LTC attached to hospital) who have experienced relief from chronic
upper
respiratory symptoms, including repeated pneumonias after being placed
on
thickened liquids.
*** But you don't know all of the variables involved. They are,
undoubtedly, aspirating the thickened liquids as well. See Logemann et
al. Perhaps, for other reasons, their resistance is better. One cannot
assume that thickened liquids are not aspirated and we now know for
certain that they are.
Research and evidence based practice are important to my practice.
However,
there is also evidence and knowledge to be gleaned from every patient
that I
treat.
*** Absolutely - but one must also know what changes, biochemical,
pharmaceutical, immunological, etc. are taking place before reaching
conclusions based on only one variable.
Those patients and their outcomes tell me that although probably
overused, there is an appropriate place for thickened liquids in the LTC
setting.
*** I, of course, would have to disagree, and, having never used them
find no reason to suggest that they do have any place - the recent study
supporting this conclusion.
> Dysphagia mail list: Normal and disordered swallowing information
> Dysphagia at dysphagia.com
> Manage subscription: http://lists.b9.com/mailman/listinfo/dysphagia
> Visit the new Dysphagia Web Forum: http://dysphagia.com/forum
_______________________________________________
Dysphagia mail list: Normal and disordered swallowing information
Dysphagia at dysphagia.com
Manage subscription: http://lists.b9.com/mailman/listinfo/dysphagia
Visit the new Dysphagia Web Forum: http://dysphagia.com/forum
Dr I Campbell-Taylor
Clinical Neuroscientist
Exclusive Distributor:
www.interactivetherapy.com
------------------------------
_______________________________________________
Manage subscription: http://lists.b9.com/mailman/listinfo/dysphagia
Visit the new Dysphagia Web Forum: http://dysphagia.com/forum
End of Dysphagia Digest, Vol 43, Issue 17
*****************************************
|
|