Conservative estimates suggest more than 560 million people worldwide live with swallowing disorders—dysphagia.
Many of those people eat specially prepared foods and liquids that are safer and easier to swallow. In recent years, a number of countries developed standardized terminology for texture-modified foods and thickened liquids to improve care and safety. However, the various published national standards only added to the confusion globally, mainly because of their varied terminology, labels, number and levels of food texture, and liquid thickness. Patient safety is affected as a result.
In 2012, the International Dysphagia Diet Standardisation Initiative (IDDSI) was launched to develop a global language for international standardized terminology for texture-modified foods and thickened liquids. The primary goal of IDDSI is to improve patient safety with standardized global terminology and definitions for texture-modified foods and thickened liquids for people with dysphagia of all ages, in all care settings, and of all cultures.
The first two big steps of IDDSI involved international reviews. The first, completed in 2013, looked at published literature and existing national standards. The next project took place in 2014, which was a systematic review of modified food texture and liquid consistency.
Next, IDDSI conducted surveys of four stakeholder groups—health professionals, patients and caregivers, industry, and researchers—throughout 2014 and 2015. More than 5,000 responses yielded overwhelmingly positive support for the initiative and a standardized international framework.
Late in 2015, an expert multidisciplinary international panel considered all of these elements in developing the international standardized framework and terminology.
The international framework for standardized classification of texture modified foods and liquids consists of eight levels rated from zero to seven. Text labels—translated into 16 different languages to date—numbers and color codes identify each of the levels. Detailed descriptions and practical objective tests of consistency/thickness are used to distinguish levels.
No more need to guess the consistency of a liquid. When you need to determine “how thick” a liquid is, simply use the IDDSI flow test! It’s as easy as finding the nearest appropriate 10ml syringe. To evaluate drinks and liquidized foods, IDDSI chose a gravity flow test using a 10ml syringe. The IDDSI website offers detailed instructions and videos on how to classify liquids based on their rate of flow.
There are four options for food testing, including the fork drip test, fork and spoon pressure test, chopstick test, and finger test. Make sure you’re not wearing nail polish when checking for thumb-nail blanching during the fork test. If you are, ask a colleague to help out!
My colleagues—Julie Cichero, Peter Lam, Ben Hanson, Joseph Murray, Catriona Steele—and I will explain more about the IDDSI framework, terminology and objective testing at our presentation later this week at the 2017 ASHA National Convention in Los Angeles. We are all members of the IDDSI board of directors and have been involved with the project since its inception.
We’ll also discuss the IDDSI global implementation plan and offer attendees tips for implementation and risk assessment. And we’ll share our own implementation success stories. In addition, we’ll give all participants a chance to try flow testing for liquids and food testing:
- IDDSI – The Next Steps: Tools & Tips for a Smooth Implementation, pre-convention workshop, Wednesday, Nov 8 at 1:00 pm in room 403B.