No doubt by now, you would have heard of IDDSI, the International Dysphagia Diet Standardisation Initiative (IDDSI). It’s an important change that is coming into effect from May 1st 2019 for Australians. It is a framework that aims to improve the safety of people with dysphagia by using standardised terminology for texture modified foods and thickened fluid, all over the world, for all ages and all care settings.
The current guidelines (Australian Standards for Texture Modified Foods and Fluids) for Dysphagia diets were developed in 2007. However, there have been new research and developments over the last 10 years, building further on our current definitions.
There are many changes required for the transition to the new framework and this will require significant planning at your homes to ensure implementation is smooth.
What are the main changes?
New texture levels
IDDSI consists of a continuum of 8 levels (0 – 7) with the respective names and colour codes which describes drinks and foods. There is also a link between the food texture and the fluid thickness and the addition of a new (slightly thick – level 1) fluid thickness. This is a new concept that covers foods like gravy and sauces, soups etc that now need to meet a fluid consistency as well as a food consistency.
In general, much of the terminology and classifications are transferable from the Australian Standards to the IDDSI framework. There are, however, some differences which will need to be taken into consideration. For example, a Level 6 (previously known as Texture A – Soft Diet) must also be of ‘bite-sized’ or cut up into ‘bite-sized’ pieces for it to be consistent with Level 6. On the outgoing standards, “Texture A – Soft Diet” did not also need to be cut-up into bite sized pieces.
New Testing Methods
Comprehensive testing methods and audit sheets for IDDSI have been developed alongside the framework. Therefore, ensuring food and fluids are consistently provided and/or produced to the specific levels. Healthcare providers, care facilities and patients can use these testing methods and audit sheets, which are all available under Resources in the IDDSI website.
The outgoing standards which will be phased out from May 2019
The incoming standards which will be phased out from May 2019
What do you need to do?
We encourage Aged care homes to start the transition process as of January 2019. To help you get started, we have listed some aspects in your home you will need to consider to help make implementation of IDDSI smoother.
Policy and Documentation Review
Which of your policies, procedures, clinical tools/charting and communication systems will be affected by IDDSI? They can include Nutrition Policies, Dietary preferences, Nutrition Assessments etc. and should be updated with the new terminology. You may even need to consult your IT services for updating forms and assessments in electronic medical record systems.
Education Sessions for staff and residents.
Provide repeated training sessions to your staff involved in care and catering. Topics need to include “What is IDDSI?”, Testing methods, practical demonstrations and Changes to Practice. Also consider including IDDSI information into orientation packages for new staff. Leading Nutrition are also holding IDDSI Workshops through the year and IDDSI will be included in all the Food for the Ages Seminars in 2019.
Focus on food service
You may need to review menu items and recipes. This will ensure your texture modified diets and fluids are consistent with the IDDSI classifications. Use IDDSI audit sheets and flow test cards (all available under Resources in the IDDSI website)
Involve your Speech Pathologist and Dietitian
The Leading Nutrition team can support your organisation with all aspects of IDDSI adoption. We can provide expert advice on planning stages, training, implementation and review.
Communicate with your networks
Different organisations and health professionals will make this transition at times that suit everyone. Therefore, clear communication with your Dietitian, Speech Pathologist, visiting GP’s, local hospitals and health services about their plans to transition will give you clear information on how best to work with other agencies during the cross over time.