STAFF TRAINING GUIDE Getting IDDSI Ready What HCPs need to know

What is IDDSI? IDDSI stands for the International Dysphagia Diet Standardisation Initiative. IDDSI is a group of volunteers working together to develop international standardized terminology and definitions for texture modified foods and thickened liquids for people with dysphagia. The IDDSI came together in 2013 to create these standards, resulting in the International Dysphagia Diet Framework, to meet the needs of individuals with dysphagia across age span, all care settings and all cultures. The framework includes food and drink descriptors along with instructions for easy, reliable and accessible methods to test different foods and drinks. Source: (c) The International Dysphagia Diet Standardisation Initiative 2016 @https://iddsi.org/framework/.

The History IDDSI Replaces the National Dysphagia Diet In the past, the National Dysphagia Diet (NDD) was the only standardized diet tool in the United States, and it was a great beginning. NDD was published in 2002 by the American Dietetic Association (ADA), now known as the Academy of Nutrition and Dietetics. It was created as an official project of the ADA, but the NDD was not officially supported by American Speech-Language Hearing Association (ASHA). However, the NDD was the result of consensus among dietitians, Speech-Language Pathologists, and food scientists. This tool listed diets that were appropriate for patients with swallowing disorders. The use of food science and the science of rheology have helped us create diets not only to avoid diet-label confusions, but also to provide for the safest textures for the patient’s particular type of dysphagia. Source: https://www.swallowstudy.com/dysphagia-diets-iddsi-replaces-ndd/ Source: (c) The International Dysphagia Diet Standardisation Initiative 2016 @https://iddsi.org/framework/.

The Thick-It® Commitment At Thick-It®, we are committed to research, innovation and education. These are the pillars of our organization as we work to find reliable dysphagia nutrition solutions for people with swallowing difficulties and their caregivers. We know that in order to find the best solutions for the more than 580 million people worldwide living with dysphagia, we must work collaboratively with experts in healthcare, food science and technology, and patient safety. Along with the new framework, IDDSI has defined food and drink descriptors and instructions to improve the safety and care for the population affected with dysphagia (estimated to be 8%). We are proud to partner as gold sponsors with IDDSI, to support a global effort to promote a set of standardized, common language terminology and definitions developed for texture modified foods and thickened liquids. Source: (c) The International Dysphagia Diet Standardisation Initiative 2016 @https://iddsi.org/framework/.

The Benefits of IDDSI Dysphagia Patients Healthcare Providers & Caregivers Standardized thickness levels are objective and predictable IDDSI labeling is designed to be easily understood by everyone, vs. potentially confusing or unfamiliar terms like “nectar” and “honey” IDDSI labeling is also designed to be clearly marked and each level is distinct. The IDDSI framework includes tests to determine where foods or drinks fall on the scale As more brands adopt IDDSI standards, it will be easier for caregivers and facilities to compare products The IDDSI initiative is led by volunteers worldwide and is supported by a number of industry leaders (such as ASHA and the National Foundation of Swallowing Disorders). IDDSI’s goal is to develop standardized terminology for texture modified foods and thickened liquids for people with dysphagia, under the objective and unbiased recommendation of this diverse group. Source: (c) The International Dysphagia Diet Standardisation Initiative 2016 @https://iddsi.org/framework/.

The IDDSI Framework The framework has eight levels (0–7). Each level has detailed descriptors that would best meet the needs of an individual with dysphagia (for more information on the descriptors, please visit www.iddsi.org). Source: (c) The International Dysphagia Diet Standardisation Initiative 2016 @https://iddsi.org/framework/.

The IDDSI Food & Drinks Classification and Testing Source: (c) The International Dysphagia Diet Standardisation Initiative 2016 @https://iddsi.org/framework/.

Flow Test HOW TO USE THE IDDSI STANDARDS The IDDSI flow test classifies IDDSI Levels 0-3 based on their rate of flow. Use a syringe (following syringe dimensions as per image below) for correct results: For example videos visit www.iddsi.org/framework/drink-testing-methods/ Source: (c) The International Dysphagia Diet Standardisation Initiative 2016 @https://iddsi.org/framework/.

Flow Test HOW TO USE THE IDDSI STANDARDS What specific syringe should I use? These may not be the only syringes that are appropriate. Just make sure the syringe measures 61.5 mm from the 0 to the 10 mm lines. Source: (c) The International Dysphagia Diet Standardisation Initiative 2016 @https://iddsi.org/framework/.

Flow Test Instructions HOW TO USE THE IDDSI STANDARDS Flow Test Instructions Videos of IDDSI flow test can be found here: http://iddsi.org/framework/drink-testing-methods/ or in the IDDSI App, available in the Apple App Store and Google Play Store. Turn over to check IDDSI level Source: (c) The International Dysphagia Diet Standardisation Initiative 2016 @https://iddsi.org/framework/.

Fork Drip Test HOW TO USE THE IDDSI STANDARDS Thick drinks and fluid foods (LEVELS 3 and 4) can be tested by assessing whether they flow through the slots/prongs of a fork and comparing against the detailed descriptions of each level. Source: (c) The International Dysphagia Diet Standardisation Initiative 2016 @https://iddsi.org/framework/.

Spoon Tilt Test HOW TO USE THE IDDSI STANDARDS Extremely thick drinks and purée foods (LEVELS 4 & 5) can be tested by using this method. Food and drinks at this level should be smooth and not require any biting or chewing. Food must pass Fork Drip and Spoon Tilt tests. See videos of the Level 5 IDDSI Fork Drip Test and IDDSI Spoon Tilt Test at: https://iddsi.org/framework/food-testing-methods/ Source: (c) The International Dysphagia Diet Standardisation Initiative 2016 @https://iddsi.org/framework/.

The IDDSI Food & Drinks Classification and Testing Recap Source: (c) The International Dysphagia Diet Standardisation Initiative 2016 @https://iddsi.org/framework/.

IDDSI Label Changes to Thick-It® Products IDDSI & THICK-IT® IDDSI Label Changes to Thick-It® Products What is changing? Updated recommended dosage to reflect the IDDSI framework. The package labels will be changing over the coming months, NOT the products trusted for over 30 years. Our products have been tested, and will continue to be tested, to ensure compliance with the new IDDSI framework and a consistent and safe experience for consumers. What products will be affected? Thick-It® Original, Thick-It® Original Foodservice, and Thick-It® Original Concentrated Food & Beverage Thickeners Thick-It® Clear Advantage® Ready-to-Drink Beverages Thick-It® Purées

IDDSI Framework & Thick-It® IDDSI & THICK-IT® IDDSI Framework & Thick-It® Example Labeling Dual Labeling New IDDSI levels will be shown alongside old (honey/nectar) terminology. Final label changes coming soon. Source: (c) The International Dysphagia Diet Standardisation Initiative 2016 @https://iddsi.org/framework/.

Additional Resources Further IDDSI resources available at www.iddsi.org The IDDSI Framework and Descriptors are licensed under the Creative Commons Attribution Sharealike 4.0 International License https://creativecommons.org/licenses/by-sa/4.0/ March 4, 2017

Schedule a IDDSI Training with Thick-It to help your staff better understand these new standards ® thickit.com/iddsi-training or call 1.800.333.0003