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Dysphagia Diet Solutions: Transitioning to the International Dysphagia
Diet Standardisation Initiative Framework
Becky Dorner, RDN, LD, FAND
President, Becky Dorner & Associates, Inc.
President, Nutri t ion Consult ing Services, Inc.
ANFP Annual Conference & Expo | Orlando, Florida | 2018
Speaker Bio and Disclosures
Becky Dorner, RDN, LD, FAND
President, Becky Dorner & Associates, Inc. and Nutri t ion Consulting Serv ices, Inc.
Author, Speaker, Consultant
Disclosures:
Becky is owner of Becky Dorner & Associates, Inc. and a consultant to Hormel Health Labs
However, there are is no conf l ict of interest for this presentation
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Contact information:
www.beckydorner.com
ANFP Annual Conference & Expo | Orlando, Florida | 2018Copyright November 2017 - Used
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The entire slide deck is not an
official IDDSI slide deck
Some sl ides are used with
permission f rom IDDSI, in
combination with sl ides of my
own (each sl ide notes whether i t
is copyrighted by IDDSI and/or
created by Becky Dorner)
Please Note
5Slide created by Becky Dorner 2018
Slides that Include the IDDSI Copyright Have Been Developed by IDDSI and are for Public Use
The International Dysphagia Diet Standardisation Initiative 2016 @http://iddsi.org/f ramework/.
Attribution is NOT PERMITTED for derivative works incorporating any alterations to the IDDSI Framework that extend beyond language translation.
Supplementary Notice: Modif ication of the diagrams or descriptors within the IDDSI Framework is DISCOURAGED and NOT RECOMMENDED. Alterations to elements of the IDDSI f ramework may lead to confusion and errors in diet texture or drink selection for patients with dysphagia. Such errors have prev iously been associated with adverse events including choking and death.
Copyright November 2017 - Used with permission from IDDSI
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ANFP Annual Conference & Expo | Orlando, Florida | 2018
1. Describe the IDDSI international f ramework
2. Explain how the new IDDSI international standards map to the various
terminologies and existing standards
3. Implement at least 3 strategies to transition to the new standardized
terminology
Objectives
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ANFP Annual Conference & Expo | Orlando, Florida | 2018
ANFP Annual Conference & Expo | Orlando, Florida | 2018Copyright November 2017 - Used
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ANFP Annual Conference & Expo | Orlando, Florida | 2018
Choking deaths around the world
in people of al l ages
2002 NDD: standardization of
terminology, def initions – meant
to be a starting point
2012:SLPs, RDs, nurses, OTs,
doctors, food technologists, and
scientists f rom around the globe
discussed development of
international dysphagia diet
standards to meet the needs of
al l indiv iduals with dysphagia
History
Overriding goal: Patient safety
2013: IDDSI was off icial ly formed
All board members are volunteers
and al l are committed to
improv ing the safety of people
with dysphagia and sharing
information f reely around the
world
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ANFP Annual Conference & Expo | Orlando, Florida | 2018
IDDSI rev iew of standards
available:
▪ 8 sets of published standards from
USA, UK, Australia, New Zealand,
Ireland, Sweden, Denmark, Japan
Multiple sets of terminology,
different diet levels and
descriptions
History
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ANFP Annual Conference & Expo | Orlando, Florida | 2018
Global Survey (>5000 responses) Findings:
▪ 27 different labels to describe liquid thickness
▪ 54 different labels to describe food textures
▪ Few used colors, numbers or symbols to help identify each one
Only 40% of respondents reported the they checked to be sure food texture
and/ or l iquid thickness was accurate right before serv ing (a key point for
ensuring patient safety)
IDDSI researched/developed a new global f ramework borrowing f rom the
best ev idence-based standards f rom around the world
History: 2013-14 IDDSI Stakeholder Survey
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ANFP Annual Conference & Expo | Orlando, Florida | 2018
ANFP Annual Conference & Expo | Orlando, Florida | 2018Copyright November 2017 - Used
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ANFP Annual Conference & Expo | Orlando, Florida | 2018Copyright November 2017 - Used
ANFP Annual Conference & Expo | Orlando, Florida | 2018Copyright November 2017 - Used
IDDSI Framework
and
Detailed Descriptors
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IDDSI’s goal was to develop a
cultural ly sensitive, age-span
relevant f ramework for classifying
texture modif ied foods and
thickened drinks.
To achieve this, they integrated
f indings f rom the existing practice
data including currently existing
dysphagia diet standards, the
results of their systematic rev iew
and global survey responses.
Background
The draf t f ramework was shared with the global community and the feedback f rom this survey was used to inform the f inal IDDSI f ramework which was published in September 2015; rev ised in August 2016
The framework and accompanying materials are l iv ing documents that wil l be modif ied as new research becomes available
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ANFP Annual Conference & Expo | Orlando, Florida | 2018Copyright 2016 - Used with
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Complete IDDSI Framework Detailed Definitions – Essential Document
to review and understand
This document outl ines:
the specif ic characteristic of the food or l iquid of that level,
the physiological rationale for the level,
reference to any ev idence supporting the level, and
recommended testing methods to be used to ensure the food or l iquid in
question meets the criteria of that level
http:// iddsi.org/Documents/IDDSIFramework-CompleteFramework.pdf
Detailed Descriptors for Foods and Drinks
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This document also includes the testing methods that are
appropriate for each level
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Testing to Ensure the Food or
Liquid Meets the Criteria of
Each Level
IDDSI Framework Testing Methodshttp:// iddsi.org/Documents/IDDSIFramework-
TestingMethods.pdf
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Size, shape, and moisture level
are crucial
IDDSI prov ides simple point of
serv ice testing helps assure that
foods are:
▪ Appropriate size
▪ Soft, cohesive, slippery (moist)
▪ NOT: Hard, crumbly or sticky
Food Testing Methods
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For hard or f irm food, a Fork
Pressure Test is used to assess foods
in Levels 4-7, and transitional foods
Fork Pressure Test: Levels 4-7
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Source: http://iddsi.org/Documents/IDDSIFramework-TestingMethods.pdf
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These recommendations are based on a rev iew of the
choking l i terature and relates to the size of
endotracheal tubes and airways
Use a maximum food sample size of 1.5 x 1.5 cm for
adults (~the size of an adult thumb nail)
▪ Press a fork into the sample until the nail blanches white
▪ This level of pressure has been quantified to be similar to
the pressure the tongue uses to generate the swallow reflex
▪ When the fork is lifted the sample should be squashed (not
splintered), and should NOT return to its original shape
Testing Safety for Level 6: Soft & Bite Sized Foods
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Source: http://iddsi.org/Documents/IDDSIFramework-
TestingMethods.pdf
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IDDSI Fork Test
Helps measure the appropriate
particle size for safety
Adults: Particle/lump size = 4 mm
(mil l imeters)
▪ Equal to width between 2 tines of a fork
This recommendation is based on the
average particle size of chewed
solids before swallowing
Testing Safety for Level 5: Minced & Moist
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Source: http://iddsi.org/Documents/IDDSIFramework-TestingMethods.pdf
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For safety the bolus should be
cohesive enough to hold i ts
shape, but not sticky
A sticky bolus can adhere to the
roof of the mouth or teeth and
cause a choking risk
Spoon Tilt Test: Levels 4 and 5 (Puree and M inced & M oist )
37Slide created by Becky Dorner 2018
Source: http://iddsi.org/Documents/IDDSIFramework-TestingMethods.pdf
ANFP Annual Conference & Expo | Orlando, Florida | 2018Copyright 2016 - Used with
IDDSI tests – Level 5 Minced & Moist demonstration video
https://www.youtube.com/watch?v=9tMowfeuzVY
Copyright December 2017 -
Used with permission from IDDSI
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Drink Testing Methods
Simple point of serv ice testing to assure that drinks are
at the correct thickness
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ANFP Annual Conference & Expo | Orlando, Florida | 2018
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Thick drinks and f luid foods can
be tested by assessing whether
they flow through the
slots/prongs of a fork, and
Comparing against the detai led
descriptions of each level
Fork Drip Test: Levels 3 & 4 (Moderately Thick and
Extremely Thick)
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Source: http://iddsi.org/Documents/IDDSIFramework-TestingMethods.pdf
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ANFP Annual Conference & Expo | Orlando, Florida | 2018Copyright 2016 - Used with
ANFP Annual Conference & Expo | Orlando, Florida | 2018Copyright 2016 - Used with
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IDDSI’s v ideo i l lustrates the IDDSI
f low test comparing thickened
l iquids Level 1-4
After 10 seconds of f low, the volume
remaining in the syringe can be
read and compared to the IDDSI
levels
Note that at level 4 there is no f low.
For Level 4, a spoon ti l t test and
fork drip test are required to ensure
the sample meets IDDSI Level 4
requirements
IDDSI Flow test – Comparison of Levels 1-4
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IDDSI Flow test – Comparison of Levels 1-4
Copyright December 2017 -
Used with permission from IDDSI
https://www.youtube.com/watch?v=rpA6rCMwfEQ
ANFP Annual Conference & Expo | Orlando, Florida | 2018
Academy of Nutri t ion and Dietetics and American Speech-Language Hearing Association (ASHA) support IDDSI
▪ Unsure when – awaiting announcements from both organizations
▪ Industry needs time to develop/test/label
Expect a minimum 12-18 months/up to 2 years to implement in a faci l i ty
Note: This is a recommendation, not a regulation, however, i t wil l be considered best practice
When Do We Need to Implement?
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Find champions in your faci l i ty, team up, plan and prepare
▪ Learn more
▪ Educate (staff, residents/patients, families)
▪ Use the IDDSI resources
▪ Start dual labeling everything: Diet orders, forms, menu terms, tray cards(manufacturers are starting to dual label)
▪ Preparation: Assess needed changes: Recipe testing, menu changes
Remember patient safety balanced with quali ty of l i fe, rights, person centered decision making
How? Where Should We Begin?
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All resources/sign up for email updates: www.IDDSI.org(webinars, videos, art icles, news, implementation guides, etc.)
You Tube Channel for IDDSI videos: https://www.youtube.com/channel/UC0I9FDjwJR0L5svIGCvIqHA/featured
Recorded webinars: https://www.youtube.com/playl ist?list=PLa8-lAnKo0KYVqygRKNJolO3dsBsAikhi
From Framework to Food: Implementing IDDSI in a Long Term Care Faci l i tyhttps://www.youtube.com/playl ist?l ist=PLa8-lAnKo0KYVqygRKNJolO3dsBsAikhi
FAQs: http://iddsi.org/faq/
IDDSI Resources: www.IDDSI.org
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Becky Dorner, RDN, LD, FAND
[email protected] – Free IDDSI
webinar (90 minutes, 1.5 CPE)
www.beckydorner.com
Facebook: Becky Dorner & Associates
Linked In: beckydorner
Twitter: @beckydorner
Thank you!
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