Water Protocol

Water Protocol Policy 

Goal 

To optimize hydration/nutrition and quality of life for residents on thickened liquids and/or who are NPO. 

Policy 

Residents on thickened liquids and/or NPO will have free access to regular, thin water/ice chips unless ruled out by Speech Language Pathologist (SLP), Nursing, or Physician. 

Safety of Water 

• The human body is about 60% water. 

• Small amounts of water aspirated into the lungs will be absorbed by the lung mucosal tissue without harm. 

• Water is pH neutral, making it compatible with other body fluids and reducing the risk of chemical injury. 

• Water provides a safe means of assessing residents with thin liquids. 

Procedure 

I. Admission and Screening: 

• Residents admitted to the facility with orders for NPO or thickened liquids will be placed on Water Protocol pending SLP screen. 

• An SLP will conduct a screen using the Water Protocol Speech Screen and Oral Care Checklist. If further evaluation is necessary, a physician’s order for "SLP Eval and Treat" will be obtained. 

• If deemed appropriate for the Water Protocol, the resident’s care plan will be updated with specific information. 

II. Resident Eligibility and Care Plan Updates: 

• Residents not appropriate for the Water Protocol will require a physician’s order stating: “Resident is not to participate in the Water Protocol.” The care plan will reflect this. 

• The Oral Care Checklist will be placed in the resident’s nightstand drawer. 

III. Water Intake and Oral Care: 

• For eligible residents, water intake is unrestricted starting 30 minutes after a snack/meal and continues until the start of the next snack/meal. This period allows for spontaneous swallows and gravity to clear any residue. 

• Prescribed thickened liquids will continue to be given with meals, snacks, and during med pass. 

• Oral care is required twice daily, especially for residents unable to clean their own teeth/dentures/mouths to reduce pathogenic bacteria contamination. 

IV. Education and Documentation: 

• Family and caregiver education is an integral part of the Protocol. All education and training provided must be documented in the medical record. 

V. Exclusion Criteria: Residents will not be included in or will require direct supervision if exhibiting any of the following: 

• Poor dentition and/or poor compliance with oral care. 

• Impulsivity. 

• Excessive coughing. 

• Discomfort. 

VI. Informed Consent: Informed consent paperwork is required only when the resident/responsible party requests the Water Protocol but the facility's recommendation is otherwise. 

References: 

• Centers for Medicare & Medicaid Services (CMS), Requirements of Participation for Long-Term Care Facilities. 

• State Operations Manual (SOM), CMS.