IDDSI Feasibility

By Jonathan Tellier

•
 Objectives

➢ Understand the goal of IDDSI.

➢ Understand purpose of the project.

➢ Know the options if a refusal of diet is to occur.

➢ Determine if implementing IDDSI is feasible.

 Standardization

• International Dysphagia Diet Standardisation Initiative

(IDDSI)
• Goal: to make diets in every hospital the same, by
placing guidelines for specific diets, to cater to all ages,
care settings, and cultures.
• Similar to the goal of the National Dysphagia Diet
(NDD), which originally had the goal to decrease the
amount of confusion in communication between
healthcare providers.
 Implementation

• Monitor-Aware-Prepare-
Adopt (MAPA)

• Best done over the course

of 2-3 years.

• Canada and Australia have

already fully implemented
the IDDSI framework.

http://iddsi.org/framework/
 Purpose

• Question: is implementing the IDDSI

framework at DSH-P feasible?

• Problem: transition from NDD to

IDDSI a patient may no longer be
served food items outside of their
given diet guidelines.

• Implementation is to take place in

October of 2019.
 Methods

71 diet orders assessed individually in Computrition and

compared to IDDSI framework guidelines.

NDD1 to Puree level 4

NDD2 and MS to Minced and moist level 5

NDD3 to Soft and Bite Sized level 6

 Results

Only two patients have diet orders not matching

guidelines for IDDSI.

Unit 23- NDDII w/puree vegetable, regular bread at meals

not soaked not cubed.

Unit 05- NDDII w/fruit as a snack and hard cooked egg.

 Puree level 4

● Physiological rationale-
● If tongue control is significantly reduced,
this category may be easiest to manage.
● No biting or chewing required.
● Pain on chewing or swallowing.
● Food specific- All food categories sit in a
mound or pile above the fork.
 Minced and Moist Level 5

● Physiological Rationale-
● Chewing not required.
● Pain or fatigue on chewing.
● Missing teeth, poorly fitting dentures.
● Food specific- 4 mm lump size
● Meat- served in gravy or sauce.
● Fruit- serve mashed, drain excess juice.
● Bread- Pre-gelled soaked breads, No regular dry bread.
Soft and Bite-Sized Level 6

• Physiological Rationale-
● Chewing is required.
● Pain or fatigue on chewing.
● Missing teeth, poorly fitting dentures.
• Food Specific- 15 mm (1.5cm)
● Meat- cooked tender
● Fruit- Serve mashed
● Bread- Pre-gelled breads very moist
• No regular dry bread unless assessed suitable by
dysphagia specialist.
 Solution

Unit 23- Soft and Bite sized diet and have a speech
language pathologist evaluate the patient to clear dry
cubed bread.

Unit 05- Minced and Moist fruit must be pureed and the
eggs must be scrambled

http://iddsi.org/framework/
 Refusals

• DSH-P under California Code of Regulations respects

the patient’s right to “refuse any treatment.”

• One study evaluated if people with mental illness

should be awarded the right to refuse treatment.

• The best option is patient centered treatment, which is

the practice of divulging all risks associated with not
complying to treatment.

Belcher (2017)
 Probates

• No Current policy exists for

refusal of diets.
• MHA deems involuntary
treatment as a last resort,
limited to when a person is a
danger to self or others.

• Probates are common practice

for medication refusals.

Belcher (2017)
 Conclusion

Implementing IDDSI at DSH-P is feasible and no further

investigation is needed.

Future diet orders until implementation of IDDSI should

be conservative to mitigate complications when
transition takes place.
 References

Zwiefelhofer, D. Making Dysphagia Easier to Swallow. Retrieved from: https://www.dysphagia-

diet.com/Images/Making%20Dysphagia%20Easier%20to%20Swallow%2011.pdf

Belcher, J. L., Diblasio, A., Siegfried, L. D., Turnquist, A. G. (2017). Overcoming medication refusal using a

patient-centered approach. Social work in mental health 15(6) 690-704. doi: 10.1080/15332985.2017.1342115

Mental Health America. Position Statement 22: Involuntary Mental Health treatment. Retrieved from:

http://www.mentalhealthamerica.net/positions/involuntary-treatment

The international dysphagia diet standardisation initiative 2016 @ http://iddsi.org/framework/

Cichero, J., Steele, C., Duivestein, J., Clave, P., Chen, J., Kayashita, J., Dantas, R., Lecho, C., Speyer, R., Lam, P.,

Murray, J. (2013). 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 (1) 280-291. doi: 10.1007/s40141-013-0024-z