Michigan Medicine recently implemented the International Dysphagia Diet Standardization Initiative (IDDSI) with a focus on patient safety The IDDSI is a global standard with terminology and definitions to describe texture modified foods and thickened liquids used for individuals with dysphagia of all ages, in all care settings, and for all cultures.
In January of 2018 a IDDSI taskforce was convened consisting of representatives from Patient Food and Nutrition Services (PFANS), Speech-Language Pathology, and Pharmacy. The taskforce included ad hoc participants representing other groups and committees including Michigan Medicine Leadership. Taskforce goals included, determining standardization for dysphagia diets between the University Hospital and the Children's and Women's Hospital, facilitating communication amongst disciplines at Michigan Medicine, developing new dysphagia menus in collaboration with PFANS's Food Service Systems Enhancement Committee (FSSEC), developing individual menus for each new dysphagia diet, determining new dysphagia diet food items and tray ticket names making them easily identifiable to staff, training PFANS staff to ensure dysphagia diet menu items being served to our patients have the appropriate texture/consistency, working with our electronic medical record (EPIC) to update dysphagia diet selections in diet order sets, and communicating with key individuals to fan-out education of the IDDSI to providers, nurses, medical team members as well as staff members who interact with patients on a dysphagia diet.
In order to provide our patients with good tasting, high-quality, safe dysphagia menu items the PFANS Executive Chef and team created many dysphagia diet menu items. Prior to being included on the dysphagia diet menus, the menu items were taste tested by the FSSEC and approved by the PFANS compliance team after meeting dysphagia diet specific consistency, texture, and particle size requirements. The PFANS compliance team utilized several tests to evaluate the dysphagia menu items. For example, the Fork Pressure Test and Spoon Pressure Test were utilized to evaluate the hardness or firmness of a food item and how easily the food item comes through the fork prongs when the food item is pressed. A Spoon Tilt Test was used to evaluate how easily a food falls from the spoon when tilted as well as how well the food item clumps together. To test beverages a Liquid Flow Test was used to test the amount of time it takes a liquid to flow in a 10 mL syringe over 10 seconds. All these tests were conducted to ensure our patients would be served dysphagia diet menu items that tasted good and could be consumed without risk of aspiration or choking.
Please see our IDDSI webinar on YouTube for more information.
Additional PFANS resources you may find helpful as you implement IDDSI at your facility include:PFANS Room Service Menus
The Nutrition Care Manual "Diet Manual" has been updated to reflect the IDDSI framework and is a great resource to help with your facility's transition. Note: A subscription is required to view the "Diet Manual" and other sections of the Nutrition Care Manual. For more information, please see IDDSI information on the Academy of Nutrition and Dietetics website.
For more information about IDDSI is available at iddsi.org/resources.
Kit Werner, PhD, MS, RDN - Director Patient Food and Nutrition Services