Supplemental Table 1: 2-day Study Protocol
RTN#1 collected the thirst intervention box consisting of two 100 ml bottles of sterile water previously frozen to a temperature between 3.5 and 4.1 ̊ Celsius; one sterile 100 ml spray bottle; individually-packaged foam Dentip oral swabs (Medline), separately packaged; and a tube of Sage mentholated lip and tongue moisturizer (Sage Medical Products Inc.)
RTN#1 poured half of the cold sterile water from one bottle into a disposable cup and placed a mouth swab into the solution. The other half of the solution was placed into the sterile spray bottle, in a cup of ice, to maintain the cold temperature of the solution.
Intervention patients were asked by RTN#1 to rate their thirst intensity and distress, using the 0-10 NRS scales (i.e., pre-procedure thirst scores.) The patient was then asked to say “yes” or “no” to the following question: “Does your mouth feel dry?” An assessment of the patient’s mouth and lips was done to determine if the patient had stickiness or dryness in the mouth or around lips or had split skin at the corners of the mouth or cracked lips.
For Intervention patients, RTN#1 washed her hands, placed the patient in a comfortable, upright position, and told the patient “I’m going to gently moisten your mouth.” RTN#1 moistened the mouth sponge and gently wiped the patient's mouth 2 to 3 times. RTN#1 then told the patient: “I’m going to gently moisten your mouth with 5 to 6 sprays of this water spray mist.” The patient was asked to open his or her mouth to receive the sprays, and RTN#1 pointed the spray tip towards the oropharynx and tongue, and depressed the plunger on the spray bottle to give up to 6 sprays, with approximately 10 seconds between sprays. RTN#1 waited 5 minutes and repeated the sequence. After another 5 minutes, the sequence was repeated. The patient received a maximum of 9 sponge wipes and 18 sprays of sterile water over a period of 15 minutes.
At the conclusion of the three sets of sponge wipes and sterile water sprays, RTN#1 applied moisturizer to the patient’s lips and tongue. After completing the 15 minute thirst intervention procedure, RTN#1 closed the intervention kit and removed it from sight, left the patient’s room and paged RTN#2 to the patient's bedside.
Usual Care patients were asked by RTN#1 to rate their thirst intensity and distress, using the 0-10 NRS scales(i.e., pre-procedure thirst scores.) The patient was then asked to say “yes” or “no” to the following question: “Does your mouth feel dry?” An assessment of the patient’s mouth and lips was done to determine if the patient had stickiness or dryness in the mouth or around lips or had split skin at the corners of the mouth or cracked lips.
For Usual Care patients, a closed intervention box was placed in each patient’s room after enrollment. RTN#1 remained in or directly outside the patient’s room and observed activities within the patient’s room, such as usual nursing care activities for a period of 15 minutes (similar to the intervention period). No protocol restrictions were placed on the patient’s usual care.
After each 15 minute period, both Intervention Group and Usual Care Group patients were approached by RTN#2. RTN#2 was blinded to the patient’s pre-procedure thirst scores, to their group allocation, and to the thirst intervention box. RTN#2 repeated the patient’s thirst intensity and distress NRS assessmentsto obtain the post-procedure thirst scores.
RTN#1 waited a minimum of 30 minutes following the conclusion of session #1 and returned to the patient; assessed pre-procedure thirst intensity, distress, and presence of dry mouth; and repeated the thirst intervention protocol for session #2. Following each session, RTN#2 obtained the patient's post-procedure thirst scores while following the above procedure to remain blinded. This process was repeated for a third session on Day #1. If the patient remained in the ICU, this process was repeated again on Day 2 for up to a total of 6 sessions in 2 days. After each session, RTN#1 also recorded any activities that occurred in the patient’s room during the intervention time period such as the subject’s activity including nursing procedures, oral care, any oral fluids received, and/or other interruptions.