Nursing Therapy Partnership: Water Protocol for Skilled Maintenance Program

Submitted by Jon Anderson, Therapy Resource – Keystone

The Power of Two: Recovery and rehabilitation require a comprehensive team working together to achieve a common goal. These goals cannot be accomplished by Therapy or Nursing alone, but a combined effort of a united team between departments. The efforts of nursing staff and therapists working together as a joint task force has brought incredible success stories within skilled maintenance programs.

Skilled maintenance programs are designed to maintain a patient’s current level of function and prevent unnecessary declines. A new skilled maintenance program Speech-Language Pathologists have implemented is a Free Water Protocol for residents on thickened liquids to decrease the resident’s risk for dehydration and increase their quality of life. The program was successful at safely decreasing resident’s risks for dehydration as well as increasing resident’s quality of life, but also provided unexpected success stories in other areas of dysphagia.

One resident had been NPO for two years and received all nutrition and hydration by PEG tube. This resident came to Legend Oaks-New Braunfels NPO and was never expected to consume food orally again. The resident was placed on the Free Water Protocol skilled maintenance program to increase her quality of life. The resident rarely wanted to get out of bed, but with the help and encouragement of nursing staff, they had the resident up every day so she can be in a safe position for swallowing. Additionally, nursing staff has assisted the patient with good oral hygiene to decrease the patient’s risk for aspiration pneumonia while on the Free Water skilled maintenance program. The resident was tolerating thin water so well with no s/s of aspiration that the Speech Pathologists began PO trials of puree with the resident. An MBSS was conducted after the resident demonstrated weeks of tolerance of therapeutic PO trials and was recently placed on a puree diet with nectar-thick liquids after not eating for two years!

Another resident on the Free Water Protocol was on a puree diet with honey-thick liquids for over a year. His skilled maintenance program was designed to decrease risk for dehydration. This resident also demonstrated good tolerance of thin liquids during the program, and Speech Pathologists began therapeutic trials of mechanical soft and regular textures with him. An MBSS was conducted, and the patient was upgraded from a puree diet to a regular diet! The resident requires cueing for safe swallow strategies, and the nursing staff has played a key role in ensuring the resident carries out safe swallow strategies on his new diet.

The teamwork between Nursing and Therapy has provided miraculous results in our residents’ lives.

“Never underestimate the ability of a small group of committed individuals to change the world; indeed, they are the only ones who ever have.”Margaret Mear