PowerPoint Presentation€¦ · USA, UK, Australia, New Zealand, Ireland, Sweden, Denmark, Japan...

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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


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:

[email protected]

www.beckydorner.com

ANFP Annual Conference & Expo | Orlando, Florida | 2018Copyright November 2017 - Used

mailto:[email protected]

http://www.beckydorner.com/

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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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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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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



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



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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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


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


http://iddsi.org/Documents/IDDSIFramework-CompleteFramework.pdf

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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



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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http://iddsi.org/Documents/IDDSIFramework-TestingMethods.pdf

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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


Source: http://iddsi.org/Documents/IDDSIFramework-TestingMethods.pdf



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


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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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 )




IDDSI tests – Level 5 Minced & Moist demonstration video

https://www.youtube.com/watch?v=9tMowfeuzVY

Copyright December 2017 -

Used with permission from IDDSI


https://www.youtube.com/watch?v=9tMowfeuzVY

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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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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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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


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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Slide created by Becky Dorner 2018


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?


https://www.youtube.com/watch?v=rpA6rCMwfEQ

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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



http://www.iddsi.org/

https://www.youtube.com/channel/UC0I9FDjwJR0L5svIGCvIqHA/featured

https://www.youtube.com/playlist?list=PLa8-lAnKo0KYVqygRKNJolO3dsBsAikhi

https://www.youtube.com/playlist?list=PLa8-lAnKo0KYVqygRKNJolO3dsBsAikhi

http://iddsi.org/faq/

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[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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mailto:[email protected]

http://www.beckydorner.com/

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