1. The New Dysphagia Diet: Understanding & Getting Prepared for IDDSI Guidelines
Developed by Denise Kelly, MEd, RDN
Presented by
Mary Piciocco, MA, RDN, FAND, CSG

2. Overview of Presentation
Who is IDDSI?
Why do we need IDDSI/a standardized system
History of Dysphagia Diets
The new IDDSI Framework
Thickened liquids: NDD vs IDDSI, how to test
Texture Modified Foods- descriptor change, new testing
Resources & How to get started

3. Standardize and Simplify Training
What/Who is IDDSI?
The IDDSI initiative is a group of international healthcare professionals (RDs,SLPs,RNs) who came together to standardize the terminology and definition of thickened products and textured modified foods.
Their #1 concern is for Safety of patients
Multiple labels and definitions can cause confusion
Food Service and Safety: for survey too!
Patient safety
Standardize and Simplify Training
Successful survey

4. Copyright November 2017 - Used with permission from IDDSI
International Dysphagia Diet Standardisation Initiative - Industry Update July 2016
IDDSI goal and purpose is: (read each line of the slide)
Copyright November Used with permission from IDDSI
copyright 2016

5. Why we need a standardized system
Safety
Multiple labels/definitions can cause confusion between facilities, healthcare staff for residents
Clinical efficiency
Avoids re-assessment to determine safe liquid & diet levels and reduces need to confirm/clarify clinical info
Commercial implications
Consistent descriptor/color coding from all manufacturers and same as hand mix product at home/in facility
Research
Using the same terminology and measuring system to be able to compare studies
Multiple labels and definitions cause confusion. Think about locations that you have visited and even the labels and definitions that you have used yourself to describe food textures and thickened liquids
There is great research going on but unfortunately, because different terms and definitions are used, we are unable to accurately compare and draw valid conclusions from the results of the research findings. Using the same terminology and measuring systems for research can help develop a larger body of evidence.

6. History: Dysphagia Diet
Before 1980: blenderized foods, baby food, instant food thickener
Late 1980’s: First pre-thickened beverages- called nectar, honey, and pudding consistency
2002: National Dysphagia Diet (NDD)
Recommended terminology, viscosity guidelines
2015: IDDSI Framework

7. This is the first publication from IDDSI which summarizes the various national terminologies and introduced the world to the need for standardizing international terminology.

8. New viscosity colors and
IDDSI Framework
New viscosity colors and
descriptors

9. Why are we doing this?
NDD no longer in print (not enough literature to support the viscosity boundaries established)
Lack of accessibility to valid measuring tool
IDDSI is evidence base so = Regulatory compliance
Other countries on board – over 22!
AND and SLPs (ASHA) on board: our “better halves!”
Transitioning information already available from AND in the Nutrition Care Manual.
(22 countries are in the process of implementation)

10. Academy of Nutrition and Dietetic support
“The Academy of Nutrition and Dietetics and the American Speech-Language-Hearing Association (ASHA) together announce their support of a new global initiative [IDDSI] to standardize diets for the treatment of people who suffer from swallowing disorders.”
~Joint Press Release January 31, 2017
Hopefully a target implementation date coming from AND and ASHA in the next 2 months.
We are currently in the Awareness Phase of the IDDSI implementation process. Nursing homes will be learning about the new IDDSI framework and determining how the diet changes may impact their facility.

11. New viscosity colors and
IDDSI Framework
Spoon Thick
Honey Thick
Nectar Thick
New viscosity colors and
descriptors

12. How we currently test viscosity
Nectar: cP
Honey: cP

14. IDDSI Flow (Viscosity) Test Requires a 10 ml syringe

15. Textured Modified Foods
Every level can be identified with a
Number
Color
Description
Integrating the findings of existing practice data, the results of the systematic review and global survey responses, the IDDSI framework was published in September 2015 and revised in August IDDSI framework has 8 levels ranging from level 0 for thin liquids to level 7 for regular texture foods. Each level is distinctly identified with a colour, number and a label. The combination of the 3 identifiers will help to limit errors in prescribing, identifying, preparing and assembling dysphagia diet orders.

16. The Names explains what it is. Makes it easier
The Names explains what it is. Makes it easier. You might call mechanically altered “ground”. Minced is like ground. Some called Dysphagia advanced a “chopped diet”. That is similar to the soft and bit sized.

17. IDDSI Testing Methods to assess different textures
Flow Test (for drinks)
Fork Drink Test (for extremely thick)
Spoon Tilt Test (puree)
Finger Test
Fork Pressure Test
Finger tests have been incorporated in recognition that this may be the most accessible method in some countries.

18. Puree testing

19. Transitional Foods: NDD to IDDSI
National Dysphagia Diet
International Dysphagia Diet Standardization Initiative
Dysphagia Level 3: Advanced or Mechanical Soft
Meats are cut up, chopped or ground (moist) Crusty dry breads not allowed Salad, raw vegetables and most fresh fruit not allowed No hard sticky or crunchy foods Mixed-consistency foods are allowed/tolerated.
Food particles are served in bite-sized pieces (less than 1 inch)
Soft & Bite Sized Level 6 Blue
Soft, tender moist foods; no mixed consistency; Foods should have a particle size no great than 1.5cm x1.5cm (9/16") for adults
Dysphagia Level 2: Mechanical Altered or Ground
Meats are ground then softened and moistened by using gravies and sauces and served no larger than 1/4" pieces Vegetables and fruits are soft cooked and bite sized (served no larger than 1/4 inch pieces) Soft breads, soups and desserts allowed.
Minced & Moist Level 5 Orange
Minced, soft and moist foods; can be scooped and shaped; easily mashed by fork, No mixed consistency. Foods that are minced, soft and moist and can be scooped and shaped (e.g., into a ball shape) should have a particle size 0.4 cm x 0.4cm (just greater than 1/4 inch) for adults.
No bread.
Soft & Bite sized- Size of food determined by diameter of esophagus
Minced and Moist- Already chewed
Source: Academy of Nutrition and Dietetics “Transition to IDDSI Diets”, NCM Diet Manual

20. Fork Pressure & Size Test
Best used to assess foods in Levels 4-7
Slot/Gaps between the prongs/tines of a standard fork measures 4mm, which provides a easy compliance measure for particle size of foods at Level 5- Minced& Moist

24. Resources on IDDSI : Audit Sheets

25. International Dysphagia Diet Standardisation Initiative - Industry Update July 2016
FAQ’s or frequently asked question documents have been developed to help clarify the framework. These reflect some of the most frequent questions sent in to the IDDSI Board.
copyright 2016

27. Take Away Start with Baby steps…. Head to IDDSI.org website
Educate Staff about IDDSI
Post an IDDSI Framework and Flow test
Inform healthcare team
Review Textures

28. Looking for more information?
Apps!
Bevolution Group Information
Denise Kelly, RD

29. Questions? Comments?