Accurate Identification
Accurate identification and management of
patients at risk for oropharyngeal dysphagia
is important to decrease morbidity and costs
associated with longer length of
hospitalizations and treatment of aspiration
related pneumonia
(Odderson, Keaton, & McKEnna, 1995)
Instrumental Examination
Videofluoroscopy and endoscopic assessment
of swallowing generally are considered the two
best instrumental tools for examination of
individuals at risk for oropharyngeal dysphagia.
Videofluoroscopy is used for severe cases at
Pullman hospital and can be done at the
bedside if the patient is too frail for transport to
radiology. Endoscopic assessments are costly
and are neither feasible nor recommended.
JCAHO 2006 Requirements
The Joint Commission guidelines in recent years
required that a screen for dysphagia be
performed on all individuals with ischemic and
hemorrhagic stroke prior to ingestion of food,
fluids, or medications.
The dysphagia screening was dropping in
January 2010 but the American SpeechLanguage-Hearing Association (ASHA), as well
as best practice guidelines, continue to
recommend that all individuals at risk for a
swallowing disorder be screened (ASHA, 2004)
Screening Tool Goals
To determine the likelihood that aspiration is
To determine the need for a formal swallow
And to determine when it is safe to
recommend resumption of oral alimentation
The 3-ounce Water Swallow Test
The 3-ounce water swallow test is a widely used
method of screening individuals who are at risk
for dysphagia and aspiration (DePippo, Holas, &
Reding, 1992). These patients may have subtle
symptoms that the screening can detect prior to
If the patient presents with obvious symptoms /
conditions (i.e.), the nurse can request a
Speech Therapy consult to conduct a complete
swallow study and forego doing the water test.
Pullman Regional Hospital’s
3-ounce Water Test Procedure
Please review the following procedure that will
be implemented on MSU and ICU
Please review the water test procedure.doc
that is the next choice after completing this
powerpoint in your healthstreams module.
American Speech-Language-Hearing Association. (2004). Preferred practice patterns for the
profession of speech-language pathology [Preferred practice patterns]. Available from
DePippo, K.L., Holas, M.A., & Reding, M.J. (1992). Validation of the 3-oz.waterswallow test for
aspiration following stroke. Archives of Neurology, 49, 1259-1261.[Abstract/Free Full Text]
The Joint Commission. (2008). Disease-specific care certification program: Stroke performance
measurement implementation guide (2nd ed.). Retrieved from
Odderson, I.R., Keaton, J.,& McKenna, B.S. (1995). Swallow management in patients on an acute
stroke pathway: Quality is cost effective. Archives of Physical Medicine and Rehabilitation, 76, 11301133.[Medline]
Suiter, D.M. (2009). 3 ounces is all you need: Perspectives on swallowing and swallowing disorders
(Dysphagia) 18 111-116 December 2009. Retrieved from
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