Best Practice Guidelines for Oral Care and Secretion Management and the Free Water Protocol

This project aimed to standardise oral care practices across Western Health acute and sub-acute settings, as a range of oral care practices had been previously identified.  By establishing evidence based best practice oral care guidelines, the project aimed to facilitate the implementation of a free water protocol for clients.  Therefore, by ensuring clients maintain good oral health, they will consequently be at reduced risk of developing aspiration pneumonia, if placed on the free water protocol (Panther, 2005).

The following oral care and free water protocol resources were developed:

Best Practice Oral Care and Secretion Management Manual

This manual was developed for the purpose of detailing evidence-based best practice guidelines for oral care.  The manual encompasses best practice guidelines for poor oral health conditions and conditions requiring secretion management, and dysphagic client populations at risk of poor oral health.  Literature reviews detailing the evidence supporting the aforementioned best practice guidelines and benchmarking information obtained from other acute and sub-acute facilities across Victoria, regarding their current oral care practices is also included after each poor oral health condition.

‘Free water protocol’ bed sign

The free water protocol was designed to provide clients with the opportunity to drink water between meals under specified conditions, therefore improving their quality of life and possibly hydration.  Those clients who have been deemed safe to drink water within the guidelines of this protocol are to have the bed sign displayed above their beds.  The bed sign aimed to highlight how the free water protocol operates, both to the client and staff involved in the client’s care.

Training programs

The training programs consisted of two presentations.  The first presentation introduced the audience to best practice guidelines for oral care and conditions requiring secretion management (and how to use the related manual), while the second instructed the staff in attendance on how to implement the free water protocol.  These two presentations were developed for two separate audiences: Speech pathology staff, and also nursing and medical staff.

Client Education Brochures

To educate clients on the free water protocol, a set of brochures were developed and produced for distribution to clients and carers.  One brochure was specifically designed using aphasia friendly principles, to allow clients with aphasia easier access to written information regarding the free water protocol.  These brochures aimed to assist the client in making an informed decision regarding the free water protocol, by detailing the risks and implications involved.

Outcome Measures

Qualitative and quantitative outcome measures were used to evaluate the training program in order to gauge its impact on staff learning and practice, and obtain feedback for future quality improvement.  These outcome measures were obtained via a confidential and de-identified questionnaire provided to presentation audiences at the commencement of the presentation pertaining to oral care and secretion management.  In addition, confidential and de-identified feedback forms were provided to presentation audiences at the conclusion of the presentation regarding oral care and secretion management, and also following the presentation regarding the free water protocol.

Downloads

Acknowledgements

This project was produced by: Renee Carman, Lauren Davies, Madeleine Dziubek, Nadia Sim, Nadene Tensen & Caitlyn Wilson.

Under the supervision of: Monique Stojkovski, Western Health & Dr. Emma McLaughlin, La Trobe University.

Reference

Panther, K. (2005). The Frazier Free Water Protocol. Retrieved 2 August, 2010 from:
http://www.slpnetwork.org/archives/Meeting%2011-06-08/Frazier%20Protocol.pdf