IDDSI launched in in the USA per ASHA and the AND in May 2019. Then COVID-19 hit. Where are you now with IDDSI implementation?

7 IDDSI Updates

by Karen Sheffler, MS, CCC-SLP, BCS-S of SwallowStudy.com

Did you know that over well over 40 nations around the world have started to implement IDDSI and formed nationwide work groups (aka, reference groups). It is inspiring to have global IDDSI meetings with large nations like Brazil, Mexico, Canada, and China, as well as smaller nations such as Iceland and Myanmar! The newest countries to join are: Azerbaijan, Portugal, and the United Arab Emirates. It truly is a global wave of standardization of food and liquid textures and dysphagia diets for the safety of people of all ages, in all settings, and across all cultures.

The American Speech-Language and Hearing Association (ASHA) along with the Academy of Nutrition and Dietetics (AND) declared that May 1, 2019 would be the official launch date for IDDSI in the USA. Then COVID-19 hit! Many facilities that were deep in the middle of IDDSI implementation were derailed. In the United States, the United States IDDSI Reference Group (USIRG) formed in early 2021 to support implementation across the nation with a large group of active volunteers who are generating resources and answering questions.

I am on the USIRG’s Communication & Advocacy and Resources & Best Practice work groups. We have been busy! Regarding resource development, we are curating and creating resources that are US-specific. We have been trying to gather resources that facilities have already created. We hope that organizations/facilities around the nation are keeping up with IDDSI updates and sharing with other facilities. It would be nice to not have everyone re-invent the wheel. However, some proprietary regulations in some healthcare organizations have prevented faster dissemination of those resources and handouts. If you are able to share with others around the nation, please contact usa@iddsi.org. You can also contact usa@iddsi.org to ask questions and provide ideas on what resources need to be developed.

Feel free to join one of our 4 committees as seen here:

United States IDDSI Reference Group (USIRG) formed in 2021 to keep up with IDDSI updates and help the nation with IDDSI implementation. These are our four committees. Email contact: usa@iddsi.org. Volunteer, ask questions, and plug-in to help!

7 IDDSI Updates & Encouragement to Connect

1. USIRG IDDSI Chart of Many Resources:

Go to —> https://iddsi.org/United-States

• USIRG IDDSI Webinars (see section #4 of the US chart): So far we have three IDDSI 101 PowerPoints for Food Service Workers & Caregivers, Healthcare Professionals, and Administrators. These are easy and quick introductions to IDDSI. The links bring you to a YouTube video where the USIRG speaker guides you through the PowerPoints.
  • Our IDDSI 201 Webinars will train the IDDSI Testing Methods across the whole framework. They will be recorded and posted soon. There will be a 201 for Food Service Workers and a more in depth 201 for Healthcare Workers (RDNs, CDMs, SLPs, etc.).
• USIRG Best Practice IDDSI Terminology (Powerpoint): It is so important to use IDDSI approved terminology. This PowerPoint teaches how it is best practice to use two identifiers when discussing or writing about the IDDSI levels. (We use two identifiers with our patients of name and date of birth and/or medical record number, so IDDSI does the same to avoid confusion). For example: Mildly Thick, Level 2; Minced & Moist, Level 5; Soft & Bite-Sized, Level 6. We cannot change these descriptive labels. For examples, a Minced diet definitely needs Moist attached to it to make it safe. Level 6 needs to be written as “Soft & Bite-Sized” as both of those terms appropriately describe how that diet can mitigate (reduce) a choking risk; the food needs to pass the Fork Pressure Test for “soft” and needs to pass the bite-size of 1.5cm to not block an airway (see Testing Methods details here). This Terminology PowerPoint also provides the 3-character approved abbreviations for your computer systems.
• Competencies: It is important to document the training that you and your coworkers are undertaking in IDDSI. We have completed the competency quizzes for some of the 101 trainings:
  • 101 Competencies for Food Service Workers & Caregivers.
  • 101 Competencies for Healthcare Professionals (coming soon).
  • We would love it if facilities would share their ideas and forms for staff competencies (i.e., how to demonstrate staff trainings). Email us as usa@iddsi.org.
  • One idea that we are developing is to use the IDDSI Audit Tools for each IDDSI level and turn them into staff training sheets for demonstrating the IDDSI Testing Methods for each level.
• Current Resource & Best Practice work group projects include:
  • Making the IDDSI Patient Handouts more user friendly to the United States audience. (They were written with some British-English vocabulary, such as Lollies, Biscuits, and Crisps!).
  • Cataloguing over 500 articles into an IDDSI literature evidence table.

I will keep you all posted on IDDSI Updates & new links above.

Readiness for IDDSI Updates starts with knowing the IDDSI framework with pyramids for solids and drinks/liquids, along with the sidebar for transitional foods. Each IDDSI level has a name, color, number and triangle icon. Use at least two identifiers when talking or writing about IDDSI levels, such as Mildly Thick Liquid, Level 2.

2. Hormel Health Labs‘ Resources:

• Hormel Health Labs’ (HHL) Full IDDSI Training Series: https://www.hormelhealthlabs.com/resources/for-healthcare-professionals/in-service-training-series-videos-information/ 
  • Request a free test kit
  • Download supplementary handouts for each course
  • Download and watch 5 video courses.
  • Disclosure: I created and recorded the 2nd and 3rd webinars on food quality control and beverage quality control, giving descriptions and testing methods for each solid and liquid level. I was given an honorarium for recording these courses, but I do not make any commission on this or on any products by Hormel Health Labs.
• Competency quizzes and learning checklist that go with these trainings. Obtain these after you sign up, making a user name and password. https://www.hormelhealthlabs.com/resources/for-healthcare-professionals/iddsi-competencies-training/. This 4-tiered competency takes a person from the basic introductory level through an advanced level to become an IDDSI champion in your facility or organization.

3. SimplyThick.com Resources

• Follow SimplyThick inventor John Holahan on tiktok (@SimplyThickJohn) when he posts on: SimplyThick mixing videos, IDDSI lessons, and food demonstrations. 
• IDDSI Funnels: Backed by years of science, the IDDSI Funnels are designed specifically for the IDDSI Flow Test and come easily marked with IDDSI Framework Levels indicated on the side. The innovative funnel top is designed so you can pour your test sample directly into the funnel without the need for another syringe.  Re-usable, dishwasher safe, and recyclable.
  • Thank you Simply Thick for helping IDDSI with distribution of these IDDSI-invented 10ml syringes for the IDDSI Flow Test. They are getting these out to the public at cost and supplies are limited at this time. IDDSI hopes to have these mass produced and distributed world-wide in the future. As of August 2022, IDDSI’s co-chair, Peter Lam, stated that IDDSI is working to streamline the process of sales and distribution of the IDDSI funnels.
  • IDDSI Funnels Purchase – Go To: https://www.simplythick.com/IDDSI-Funnels
  • IDDSI Flow Test Instructions (YouTube)
  • IDDSI Flow Test – Comparison of Levels 1-3 (YouTube)
  • Check out Flow Test cards in different languages
  • NEW Flow Test Cards using the Funnel: Large folded table reference card and the Pocket card of the IDDSI Funnel Flow Test. These can be used as “Instructions For Use” documents or IFUs.
  • Flow Test video with the new IDDSI Funnel – coming soon
  • Distribution worldwide – coming soon

IDDSI Funnel for IDDSI Flow Test. Similar to the 10ml syringe, but the top is wider for easy pouring into the syringe. Markings on the side make measuring liquids clear for testing IDDSI levels 1, 2, 3.

4. Food Scientists & Chefs Train IDDSI:

a. IDDSI Webinar on Myths & Truths:

Peter Lam (IDDSI co-chair) hosted this myth busting online event with expert rheologist and IDDSI Testing guru Dr. Ben Hanson and dysphagia culinary and foodservice specialists Preston Walker and James Ball from Oak House Kitchen. The live panel discussion will cover the science involved and the culinary know-how behind making food for the IDDSI Framework. Go to IDDSI’s YouTube Link: https://youtu.be/mQ75b7sKxtU.

b. More IDDSI & Oak House Kitchen Webinars:

• The Science Behind IDDSI: Dr. Hanson, IDDSI Board Director, is joined by Peter Lam (IDDSI Co-Chair), and discusses the science and methodology behind IDDSI testing methods

• Myths and Truths about Modifying Foods for IDDSI levels. Preston Walker and James Ball, of Oak House Kitchen, have been training healthcare catering for over 10 years. Their current focus in this field is on the transition to the IDDSI standards and have been working on how best to achieve this.

c. Rubiconfoods.com

Some chefs and dietitians from the USIRG and Rubicon Foods have teamed up with Pineapple Academy, LLC to make quick videos on how to prepare foods and drinks IDDSI-style. To see examples of how to puree, vacuum seal, shape and plate meats to prepare a perfect Pureed, Level 4, check out this free sneak peak to their trainings: www.rubiconfoods.com/iddsi/.

5. E-Bites & IDDSI website: Stay Informed of Any IDDSI Updates & Events

• Sign up for IDDSI Global’s e-bites / newsletters
• Check out the e-bites for the USIRG at the bottom of our resources chart here: https://iddsi.org/United-States.
  • Also at the bottom of that chart are email contacts for each of the four USIRG committees.
  • New FAQ section in our USIRG chart with answers to burning questions about 1. Exceptions: Bread and Mixed Consistencies, and 2. Sauces, Gravies, and Condiments
• Follow IDDSI on social media: Twitter, Instagram, LinkedIN
• Follow IDDSI on YouTube for great food and drink testing videos and many webinars. These cover IDDSI across all ages and the continuum of care. These will help you train your staff. Many of these food and drink testing demonstrations have been translated into other languages. My favorite one to add to training PowerPoints is the beginning of this one that covers some of the choking dangers of bread: https://youtu.be/W7bOufqmz18
• Download the IDDSI app. You can even use this in a person’s home to train the person with dysphagia and their caregivers. Once the content is downloaded, you can view it without the use of wifi.
• Check out popular IDDSI training posters.
• IDDSI has been translated into 20 languages so far. See available translations and how you can help expand this list.

6. Keep Asking Questions, such as:

Is IDDSI Mandatory? Do I have to Change?

Can you give me a list of IDDSI approved foods?

I will answer these questions with slides from my PowerPoints that answer them in a pretty way! Here is a link from IDDSI.org, sharing about how IDDSI is now the only professionally-recognized standard of care.

Feel free to use any images or let me know if you need PowerPoint content. IDDSI’s mission has always been to make content free and accessible around the world.

We need to clear up common confusions and misunderstandings about what IDDSI is:

• • • IDDSI does not mandate what patients are or are not allowed to have. That is a decision to be made by the whole medical team, of which the person with dysphagia is the driver. IDDSI pairs with person-centered care well.
    • IDDSI does not mandate what you as a dysphagia clinician or registered dietitian recommend for the person with dysphagia.
      • What mandates care are the decisions made by the person, considering their goals of care, wishes, and preferences.
      • Good documentation supports those decisions.
      • See USIRG’s new FAQ section that addresses exceptions to the IDDSI Framework.
    • IDDSI is a set of standardized labels, descriptors and definitions for foods (regular through puree) and drinks (thin liquid through extremely thick).
    • IDDSI provides testing methods to prepare and test foods to standardize what is potentially easier and safer for an individual with difficulty chewing, swallowing or clearing foods through the mouth, throat and esophagus.
    • IDDSI is a tool to help you clearly discuss options related to consuming foods and liquids.
      • We finally are all talking the same language, understanding what we mean by “soft,” “puree,” “thick liquid,” “easy to chew,” and more.
      • Old diet labels (such as “mechanical soft”) have no standard definitions and have been the source of numerous choking deaths around the country.
      • Old diet systems (such as National Dysphagia Diet) were too subjective and did not have testing methods or descriptors based on evidence.
      • Read more on Why IDDSI? in this mission statement found in our USIRG resource chart.
    • Clinicians have a conversation with the person (and/or healthcare proxy if the person is deemed unable to make complex decisions).
      • IDDSI does not dictate what is best or safest for the person. One cannot prevent aspiration and/or choking 100% of the time. We offer options to mitigate risks, though.
      • Clinicians use their clinical judgement, expertise, evidence-based practice, guidance from comprehensive dysphagia evaluations (that may include instrumental evaluations) to make recommendations.
      • Clinicians provide options (aggressive through palliative, as appropriate). We provide education, counseling, and potential prognostic information (i.e., are you having difficulty swallowing, what can we do about it, and how long will it take to get better?). Sometimes we recommend diet modifications temporarily for very acute problems while waiting for further testing, resolution of symptoms, and/or for a targeted therapy program to hopefully improve the swallowing and mealtime success. Sometimes diet modifications are needed more long-term. Each person is an individual.
      • The medical team, which includes the person with dysphagia, discusses and considers options. It is the person (or healthcare proxy) who makes the informed decision on care without coercion of waiver forms (which have been used when a person does not agree with the recommendations of a healthcare provider, who is not using person-centered care). 

7. Connect & Volunteer