• Helen Kenedi, JoBeth Campbell-Vance, Jenny Reynolds, Michael Foreman, Christine Dollaghan, Dion Graybeal, Ann Marie Warren, and Monica Bennett.
• Helen Kenedi is a clinical faculty member in the Communication Disorders program, School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, Texas; JoBeth Campbell-Vance is a board certified specialist in swallowing and swallowing disorders at Baylor Scott & White Institute of Rehabilitation, Hospital Division, Dallas, Texas; Jenny Reynolds is an advanced clinical specialist in the neonatal intensive care unit at Baylor University Medical Center, Dallas, Texas; Michael Foreman is the chief of the Division of Trauma, Critical Care and Acute Care Surgery, the medical director of the Trauma and Neuro-trauma Intensive Care Unit, the codirector of the Car-diothoracic and Transplant Intensive Care Unit, and the codirector of critical care services at Baylor University Medical Center; Christine Dollaghan is a professor in the Communication Sciences and Disorders program at the University of Texas at Dallas; Dion Graybeal specializes in neurology and is the medical director of stroke at Baylor University Medical Center; Anne Marie Warren is a licensed psychologist and associate investigator of trauma research at the level I trauma center at Baylor University Medical Center; Monica Bennett is a biostatistician at Baylor Scott & White Health, Dallas, Texas. kenedi@utdallas.edu.
• Crit Care Nurse. 2019 Jun 1; 39 (3): e9-e17.

BackgroundFree water protocols allow patients who aspirate thin liquids and meet eligibility criteria to have access to water or ice according to specific guidelines. Limited research is available concerning free water protocols in acute care settings.ObjectivesTo compare rates of positive clinical outcomes and negative clinical indicators of a free water protocol in the acute care setting and to continue monitoring participants discharged into the hospital system's rehabilitation setting. Positive clinical outcomes were diet upgrade, fewer days to diet upgrade, and fewer days in the study. Negative clinical indicators were pneumonia, intubation, and diet downgrade.MethodsA multidisciplinary team developed and implemented a free water protocol. All eligible stroke and trauma patients (n = 104) treated over a 3-year period were randomly assigned to an experimental group with access to water and ice or a control group without such access. Trained study staff recorded data on positive outcomes and negative indicators; statistical analyses were conducted with blinding.ResultsNo significant group differences in positive outcomes were found (all P values were > .40). Negative clinical indicators were too infrequent to allow for statistical comparison of the 2 groups. Statistical analyses could not be conducted on the small number (n = 15) of patients followed into rehabilitation, but no negative clinical indicators occurred in these patients.ConclusionsLarger-scale studies are needed to reach decisive conclusions on the positive outcomes and negative indicators of a free water protocol in the acute care setting.©2019 American Association of Critical-Care Nurses.

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