Last spring, ASHA announced its support for the International Dysphagia Diet Standardisation Initiative (IDDSI) framework. This new framework standardizes terminology and definitions for food textures and liquid thicknesses. The framework was designed to avoid the confusion created by the different names used throughout the world to describe texture-modified foods and thickened liquids, so as to ensure patient safety. The IDDSI framework includes characteristics and examples of food or liquid at each level, testing methods, as well as photos and videos of the testing methods. Public access articles published to support the evidence behind the framework are also available.
Global implementation requires attention to practice standards in different settings and countries, affiliations with various stakeholders, and development of a process for sharing strategies. Many sites across the U.S. have already begun the implementation process. The process of implementation will improve patient safety and might result in stronger interdisciplinary ties.
Is it possible for people with dementia to eat familiar and favorite foods safely? A growing number of clinicians say yes.
As many ASHA members move forward with IDDSI implementation at their respective facilities, the IDDSI board of directors prepared and shared materials.
These include posters, conversion charts, audit sheets, materials specific to food-service needs (such as diet code abbreviations) and, most recently, implementation guides. Materials are designed for clinicians and health care providers and food-service and catering professionals. There are also industry and cross-sector master guides. IDDSI co-chairs Peter Lam and Julie Cichero created many of the materials, which were approved by the board. Input for the development of the guides came from experiences in New Zealand, Australia, Germany, Canada, the U.S. and other participating countries.
In the U.S., many started the aware phase, some are in the prepare phase, and a few began the adopt phase. Implementation tips are listed below with a detailed outline available online:
Tips for starting implementation include:
- Become familiar with IDDSI. Download the free app available for iOS and Android platforms.
- Decide who will participate on the implementation/leadership team(s). In some settings, this team is composed of the head of speech-language pathology and the head of clinical nutrition. In others, food service controls new programs. Yet at others it’s all three.
- Who is the administrator to approve commencement of the IDDSI framework implementation at your facility/network? This may well be a vice president, a regional director or another appropriate administrator within your organization.
- Who are the next level of target supporters? Once you identify the leadership team, who else can support implementation? In many settings, SLPs and registered dietitians might fill this role. Some places rely on food service managers for overseeing the process.
Upon agreeing on moving forward with the IDDSI implementation, one of the initial steps is to begin the “mapping” process. This means matching your menus to the IDDSI framework. A few things to consider:
- In what order will foods/drinks be tested?
- Will menus be grouped by current categories—puree, soft—or by availability of items at each meal?
- Will one group of volunteers map the entire menu or will your facility organize specific teams to map different parts of the menu?
- Who will oversee the mapping process and ensure good inter-rater reliability?
Other items to consider:
- Necessary changes in kitchen operations.
- How to train key personnel. Food services staff need to be trained and need to understand the relevance of the IDDSI framework. Others to train include nurses, physicians, aides and other staff.
- The impact of a change in the ordering/classifying system on electronic medical records, food service matching, and other processes.
- Needed change in policies. Most facilities follow the Academy of Nutrition and Dietetics (AND) manuals and guidelines. These manuals, including electronic versions, have now incorporated the IDDSI framework.
- Implementation date(s). Will this happen by unit or will it entail rollout to the entire facility or entire network?
Your facility will face challenges in implementing the IDDSI framework, but the benefits will most likey gain full support from your colleagues. We are adding new resources to our website, and those of us on the volunteer IDDSI board can offer guidance as you begin implementation. Email us at email@example.com.
Have you started implementation of IDDSI? Share your success stories, tips or questions in the comment section below.
Luis F. Riquelme, PhD, CCC-SLP, BCS-S, is associate professor of speech-language pathology and program director for the Certificate in Pediatric Dysphagia program at New York Medical College, Valhalla, New York. He’s also the director at the Center for Swallowing & Speech-Language Pathology for New York-Presbyterian Brooklyn Methodist Hospital. Riquelme is an affiliate of ASHA Special Interest Groups 2, Neurogenic Communication Disorders; 13, Swallowing and Swallowing Disorders (Dysphagia); 14, Cultural and Linguistic Diversity; 15, Gerontology; and 17, Global Issues In Communication Sciences and Related Disorders. firstname.lastname@example.org