Assessing Knowledge, Usage, and Perceptions of the Frazier Free Water Protocol: A Pilot Study

Dysphagia is very common among hospitalized patients and is associated with increased length of hospital stay, morbidity, and mortality. Diet restrictions for dysphagia cause dehydration and discontent. The Frazier Free Water Protocol (FFWP) was developed to improve hydration and quality of life in dysphagia patients by establishing the safety of allowing sips of water between meals. Despite these potential benefits, we hypothesized that the FFWP is not widely utilized. We sought to determine barriers to utilization by assessing the familiarity, usage, and perceptions of the FFWP among health-care providers at our institution.

We distributed an anonymous questionnaire to a convenience sample of nurses in the hospital during daily huddles. The questionnaire was adapted from a validated framework to assess provider acceptability of health-care interventions.

Of the 66 surveys distributed, we had 58 completed (88%). Only 10 nurses (17%) had heard of the "FFWP" by name. For those that were familiar with the indications, benefits, and risks of giving free water to patients with dysphagia (n = 18), less than half (39%) reported doing so. No nurses that had less than 10 y of patient care experience gave water to dysphagia patients, even if they knew the indications, benefits, and risks. Similarly, less than a fifth (19%) of all nurses surveyed were comfortable giving water to dysphagia patients, but comfort increased for some if the protocol was recommended by a speech-language pathologist (33%) or physician (13%). Nursing experience of >10 y or in intensive care settings did not yield significant differences in knowledge, usage, or comfort level than those with less years or nonintensive care experience, respectively.

Nurses are essential to the implementation of the FFWP, yet many are unfamiliar and uncomfortable with utilizing it. Education about the protocol is necessary to improve patient outcomes and quality of life. We plan to provide targeted education about the FFWP as well as assess other members of the health-care team, in an attempt to increase utilization of the protocol and improve dysphagia management.