1. Diet Compendium Update: Diet Texture and Consistency Changes
Jean Helps, RD Regional Clinical Nutrition Manager Long Term Care

2. WRHA Feeding and Swallowing Expert Review Group
RD and SLP representation
Site representation:
Concordia Place
Deer Lodge Centre
Golden Links Lodge
Grace General Hospital
River Park Gardens
Victoria Hospital
WRHA Home Care

3. Feeding and Swallowing Executive Summary
Goal: Review the literature and evaluate practice to determine the continuum of texture and consistency modified diets.
Conclusion: IDDSI recommendations are current best practice

4. Copyright November 2017 - Used with permission from IDDSI
International Dysphagia Diet Standardisation Initiative - Industry Update July 2016
Copyright November Used with permission from IDDSI
copyright 2016

5. Copyright November 2017 - Used with permission from IDDSI
International Dysphagia Diet Standardisation Initiative - Industry Update July 2016
Copyright November Used with permission from IDDSI
copyright 2016

6. Copyright November 2017 - Used with permission from IDDSI
International Dysphagia Diet Standardisation Initiative - Industry Update July 2016
Copyright November Used with permission from IDDSI
copyright 2016

7. Copyright November 2017 - Used with permission from IDDSI
International Dysphagia Diet Standardisation Initiative - Industry Update July 2016
Copyright November Used with permission from IDDSI
copyright 2016

8. Middle of the (current) Continuum
International Dysphagia Diet Standardisation Initiative - Industry Update July 2016
Middle of the (current) Continuum
Soft
Soft-minced
Minced
Total minced
copyright 2016

9. Copyright November 2017 - Used with permission from IDDSI
International Dysphagia Diet Standardisation Initiative - Industry Update July 2016
These standardized changes are needed for patient safety, clinical efficiency, ease of use of commercially prepared products, and development of clinical evidence.
Copyright November Used with permission from IDDSI
copyright 2016

10. Copyright November 2017 - Used with permission from IDDSI
International Dysphagia Diet Standardisation Initiative - Industry Update July 2016
Copyright November Used with permission from IDDSI
copyright 2016

11. Copyright November 2017 - Used with permission from IDDSI
International Dysphagia Diet Standardisation Initiative - Industry Update July 2016
Copyright November Used with permission from IDDSI
copyright 2016

12. IDDSI Framework The framework consists of food and fluid consistencies
Levels are identified by text labels, numbers, and colour codes to improve safety and identification
Note “Regular (7)” has a subcategory: “Easy to Chew”
not all aspects of the framework need to be adopted to be IDDSI compliant.

13. Phase 1 Changes Coming May 2019
Copyright November Used with permission from IDDSI
Phase 1 Changes Coming May 2019
FUTURE USE X X X

14. Changes from Manufacturers
Manufacturers of modified foods and fluids are moving towards meeting IDDSI guidelines starting in January 2019
You will start seeing dual labelled thickened liquids in 2019
Once you finish using your site product and
suppliers have depleted their old labelled product
Within WRHA – changes to take place after April 2019

15. Commercial Products Nestle ThickenUp and Nestle ThickenUp Clear
In the process of transitioning to IDDSI labels
Lynch Thickening Powder
No designation on the label currently re: diet terminology
Sysco Thickened Juice and Water
Not yet transitioned to IDDSI labeling
Hormel Thickened Milk
Transition complete for Nectar Thick
Not yet transitioned for Honey Thick
Oasis Hydra ?

16. ThickenUp & ThickenUp Clear
30 sites noted they use Nestle products,
2 sites noted Lynch and Sysco
Haven’t heard from all sites
Blue highlighted occurred a few weeks ago, sites should be seeing these products soon
Yellow highlighted occurred more recently, supplier to provide a better sense of the time frame for transition soon

17. Prevalence of Texture Modifications
Dysphagia prevalence in LTC has been estimated to be over 66% (Dietitians of Canada)
Within WRHA approximately 50% of PCH residents are on texture modified diets
7% of residents are on thickened liquid diets

18. What is involved to ADOPT?
Implementing IDDSI will take time and will involve changes to:
Kitchen related:
Food and liquid definitions
Production process and recipes
Production lists (tallies), diet compliances in recipes
Food and liquid terminology
Menus, diet manual, lists, orientation material
Point of service considerations, including testing
Site wide related:
Education to staff in several departments
Updating diet information and forms
Updated policies and procedures

19. Support for Implementation
Visuals:
What and Why of IDDSI
Transition Table comparing current and new diet terminology
Industry resources
IDDSI Resources
Diet definitions and descriptions
Food Audit forms and process
Education Session held January 22 and 23

22. Copyright November 2017 - Used with permission from IDDSI
FUTURE USE X
= No Fluids X
= Pediatric Only X
= Regular

23. Industry Resources
Blue rather than yellow spoon

24. Dual Labelling Lyons Magnus/Sysco Juice

25. Hormel Milk Old label New label

26. IDDSI Resources
Diet Descriptions
Audit forms and process

27. Copyright November 2017 - Used with permission from IDDSI

28. Copyright November 2017 - Used with permission from IDDSI

29. Education Sessions – January 22 and 23
Representation from 38 of 39 sites
Food Service representation from all sites except 9
Clinical Dietitian representation from all sites except 3
Some sites had 3 representatives from a variety of roles
All LTC SLP attended
Two nursing leaders attended
Total of 70 attendees

30. Education Sessions – Feedback
Question:
Yes No
Better Awareness 46
Concerns 25 18

31. Education Sessions – Comments
Concerns:
Transition is difficult for staff
Training staff – time and resources and staff comprehension
Buy in/acceptance of the change
What will help?:
Resources – posters
Standardized recipes
Seeing the chart made it easier and the flow test is pretty straightforward
Locally produced video

32. Education Sessions – General Comments
Great session, Very informative session
Information was very clear
Excellent hands on session
Ability to access a contact easily should any concerns arise, but very informative
Thank you for the opportunity, great session, I wish my FSS and lead cook attended
Slow roll out (e.g. fluid first) will allow for a greater success in transitioning
Support for providing education – not just the RD
Food Texture update will be more of a challenge

33. Recommendation for Future Focus… Implementation of food textures in 2020
Review Food Textures and compare this to our current diets
Current Terminology
New Terminology
Standard
Standard/Regular (7)
Soft/Soft Minced
Easy to Chew (subcategory 7)
Minced
To be determined
Total Minced
Minced and Moist (5)
Pureed
Pureed (4)
Blenderized
Liquidised (3)

34. Our plan moving forward…
Identify a transition date
Finalize package for transition
Finalize education materials
Initial goal: transition fluids within the first quarter of 2019/2020
Future plan: transition foods in 2020 (?fall 2020)