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IDDSI?T H E N E W I N T E R N AT I O N A L D Y S P H A G I A D I E T
S TA N D A R D I Z AT I O N I N I T I AT I V E
P R E S E N T E R : S A R A B R O W N I N G , M S , R D N , C D
DISCLOSURESARA BROWNING
• Serves as the Outpatient Clinical Nutrition Manager for Primary Children’s Hospital,
Intermountain Healthcare
• Previously served as the Patient Care Manager at Primary Children’s Hospital, with
responsibilities over patient room service, and formula systems
• Receives no compensation for educating about IDDSI
• No affiliations outside of Intermountain Healthcare
DYSPHAGIA: THE BASICS
• 8% of the world population
• 590 million people worldwide living with dysphagia
• 1 in 25 adults with dysphagia
• 1/3 develop pneumonia, 60,000 die
• 25% - 45% of children
Cicero, Julie, 2013 IDDSI Report
http://www.asha.org/PRPSpecificTopic.aspx?folderid=8589942550§ion=Incidence_and_Prevalence
DYSPHAGIA: THE BASICS
History of Dysphagia
• Little thought given to look of food
• Foods thickened with other foods
• Pureed and baby foods were the norm
• No standards
DYSPHAGIA: THE BASICSNDD GUIDELINES
Dysphagiga Guidelines
• NDD – National Dysphagia Diet Levels
• Established in 2002
• Aim to establish standard terminology
and practice applications
• Thickened Liquids Levels not included
• Doesn’t address pediatrics
http://leader.pubs.asha.org/article.aspx?articleid=2292328
THE BASICS
Type of Dysphagia
• Oral dysphagia refers to difficulty in the passage of
liquids or food from the mouth to the esophagus.
• Pharyngeal dysphagia refers to difficulty with the
passage of food through the pharynx to the
esophagus.
Stages of Dysphagia
• Oral Phase
• Pharyngeal Phase
• Esophageal Phase
http://www.ialp.info/FAQs%20from%20the%20Dysphagia%20Committee
http://www.asha.org/public/speech/swallowing/Feeding-and-Swallowing-Disorders-in-Children/
THE BASICS
Causes of Dysphagia
• Pediatrics – prematurity, cleft lip, nervous system disorders
• Adults – Stroke, head or neck cancer, Parkinson's…
Diagnosis of Dysphagia
• Flexible endoscopic Evaluation
– Conducted by ENT and Speech Therapy
– Less common, used if vocal chord concerns
• Clinical Feeding Evaluation
– Conducted by Speech Therapy
• Modified barium swallow study
– Administered by a Radiologist and Speech Therapy
Treatment of Dysphagia
• Medical intervention
• Direct feeding therapy
• Nutrition changes
• Behavior management
http://www.ialp.info/FAQs%20from%20the%20Dysphagia%20Committee
http://www.asha.org/public/speech/swallowing/Feeding-and-Swallowing-Disorders-in-Children/
WHAT DOES A DIETITIAN DO?
Food Services
– Menu/Recipe preparation
– Accuracy verification
– Tech education
– Multidisciplinary collaboration
Medical Nutrition Therapy
– Treated through a team approach
– Team may include
• Occupational therapist
• Physical therapist
• Physician and/or nurse
• Dietitian
• Developmental Specialist
The IDDSI Board is a team of volunteers, consisting of dietitians, speech pathologists,
food scientists, physicians, occupational therapists, engineers, nurses, and
professionals who have come together to help create the IDDSI framework.
IDDSI OVERVIEW
• Background
– “Names, the number of levels of modification, and characteristics vary within and across
countries”
• Objectives
– Standardized way of naming and describing texture modified foods and thickened liquids
– Person-focused, rather than profession focused. Global terminology that will ‘work’ for all
cultures
– Common language that can be used for technical, cultural, professional and non-
professional uses.
• Academy & ASHA Acceptance
– Press Release January 2017http://iddsi.org/about-us/
IDDSI & NDD
IDDSI NDD
Regular Diet
NDD3 Advanced
NDD2 Mechanical Soft
NDD1 Pureed
Spoon/Pudding Thick
Honey Like
Nectar Like
Half Nectar
IDDSI IN PRACTICE
Liquid Testing Methods - Testing Viscosity
• Materials
– 10 mL slip tip syringes
– Stop watch
• Method
– Stop the syringe and fill with 10 mL of liquid
– For 10 seconds, allow the liquid to flow
– Note the liquid level
• http://iddsi.org/framework/drink-testing-methods/
IDDSI IN PRACTICE
Food Testing Methods - Testing Consistency
• Method
– Fork Drip Test
– Fork Pressure Test
– Chopstick Test
– Finger Test
• Test to develop recipes
– Don’t test every time
• http://iddsi.org/framework/food-testing-methods/
IDDSI IN PRACTICE
Menu Tips & Tricks
– Keep It Simple
– Use What You Already Have
– Use Ready Made Products
– Know Your Audience
IDDSI IN PRACTICE
Making the Switch
• Food particles will be smaller
• Peds lump sizes differ from adults
• Pepper is back
• Buy a blender
• Excess fluid must be drained
IDDSI IN PRACTICE
• Improving the patient experience
– Goal is always to find the least restrictive food modification
– Visual appeal is half the battle
LET’S PRACTICE
Scenario 1
• 70 year old patient
– Speech therapy recommends Level 4
– Patient wants something hot and savory
Task
• Develop an appropriate meal
• What testing method should you use to verify safety?
LET’S PRACTICE
Scenario 2
• 6 year old patient
– Speech therapy recommends Level 5
– Patient wants dry cheerios to eat
Task
• Is this safe as a transitional food?
• What test should you use to verify safety?
INTERMOUNTAIN IMPLEMENTATION
• System Wide Roll-Out
– Project Leader – Paul Osborne
– Phase 1- Preparation
• Benchmark process
• Expected 200-300 hours or work
– Phase II – Roll Out
• iCentra Order Rebuild
• Computrition Reconfigure
RESOURCES
• IDDSI.org
• Generalmillscf.com
• Dysphagia Cookbooks
• US Foods
REFERENCES
• Agency for Health Care Policy and Research (AHCPR). (1999). Diagnosis and treatment of swallowing disorders (dysphagia) in acute-care stroke patients [Evidence Report/Technology Assessment No. 8, AHCPR Publication No. 99-E024]. Rockville, MD.
• Arvedson, J. C. (2008). Assessment of pediatric dysphagia and feeding disorders: Clinical and instrumental approaches. Developmental Disabilities Research Reviews, 14, 118-127.
• Feeding and Swallowing Disorders in Children. American Speech Language Hearing Association, 2017 http://www.asha.org/public/speech/swallowing/Feeding-and-Swallowing-Disorders-in-Children/. Accessed August 20, 2017.
• Bhattacharyya, N. (2014). The prevalence of dysphagia among adults in the United States. Otolaryngology–Head and Neck Surgery, 151, 765–769.
• Complete IDDSI Framework Detailed Definitions: International Dysphagia Diet Standardization Initiative. 2017.
• Cichero, Julie. “The Need for International Terminology and Definitions for Texture-Modified Foods and Thickened Liquids Used in Dysphagia Management: Foundations of a Global Initiative”. Current Physical Medicine and Rehabilitation Reports. vol 1. Dec 2013. p 280-291
• Academy of Nutrition and Dietetics, American Speech-Language-Hearing Association Support New Global Standardization of Diets forSwallowing Disorders. Academy of Nutrition and Dietetics. 2017.
• Lam, Peter et al. “International Dysphagia DietStandardisation Initiative: Categoriztion Framework, Labels and Terminology”. The IDDSI Committee. 2015. The http://iddsi.org/wp-content/uploads/2016/05/IDDSI-ESSD-Poster-September-2015.pdf Accessed August 20, 2017.
