 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)

 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.

 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 Speech-
Language-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)

 To determine the likelihood that aspiration is present
 To determine the need for a formal swallow evaluation
 And to determine when it is safe to recommend resumption of oral alimentation

 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 complications.
 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.

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 www.asha.org/policy
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 ( 2 nd ed.). Retrieved from http://www.jointcommission.org/NR/rdonlyres?978361C-5F44-4416-A8B6-C6EE92F6CB2D/0/stroke
_pm_implementation_guide_ver_2a.pdf
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, 1130-
1133.[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 http://div13perspectives.asha.org/cgi/content/full/18/4/111