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Implementing the IDDSI Framework

What is IDDSI?

The International Dysphagia Diet Standardisation Initiative, or IDDSI for short, is an international collaboration between speech and language therapists, dietitians, food scientists and industry professionals with the aim of creating a global standard for terminology around dysphagia. The aim is to have a common language which can be used across the board, whether it be for technical, patient, cultural or non-professional uses. The IDDSI framework is the first to include both foods and liquids, and consists of a continuum of eight levels (0-7) which include standardised terminology and definitions. Each level has specific standards with clear characteristics and specifications, and has been assigned specific tests to determine if a meal is compliant.

apetito Dietitian, Helen Willis explains what IDDSI will mean for the industry, “A lot of the changes involve tightening up on the texture descriptors, but the IDDSI framework also gives us a clearer understanding of how to assess whether a meal is compliant. This has been missing before, making it quite hard to manufacture texture modified foods while knowing we are hitting the correct textures every time. Dysphagia is a life-threatening condition and ensuring someone eats and drinks the correct texture for them could be life altering, or potentially fatal if not done correctly.”

IDDSI allows healthcare professionals and patients to travel, not only between care settings, but from country to country, without causing confusion or compromising the safety of those living with dysphagia. Previously patients would often need to be reassessed when moving from an acute care hospital to a long-term care home as the dysphagia diet terms were often interpreted in different between care facilities. The implementation of the IDDSI framework aims to overcome these challenges, thus improving patient safety.


What steps do hospital caterers needs to take to ensure compliance?

The IDDSI transition will be a major change for the entire industry, impacting all involved in patient care, especially those delivering patient catering services within hospital kitchens. To ensure hospital caterers are compliant, firstly it is important for teams to be aware of and understand the IDDSI framework and the changes being introduced. The IDDSI website and mobile app have a variety of resources available to food service and catering teams on ways of managing the implementation. It is recommended care providers introduce the IDDSI terminology as soon as possible to reduce confusion in service users and reduce issues when they move between care settings or teams.

Helen explains the key steps caterers should take to ensure the food served is IDDSI complaint, “The steps you need to take depends on whether the meals are being made on site or being bought from a supplier. If you are buying texture modified foods from apetito, you will not need to do anything to make sure you are compliant, as we have done all the hard work to ensure it’s taken care of. If you are buying from another supplier, you need to make sure it is changing its texture terminology and the texture of its food to be compliant with IDDSI. If you are making your own texture modified food on site, you will need to see the IDDSI texture descriptors and make sure foods created on site meet the criteria set out.”

Appropriate resources will be available from both IDDSI and suppliers to support healthcare providers in the transition to the new framework. Kelly Fortune, Development Manager at apetito adds, “Audit sheets are available on the IDDSI website, these can be used to check the meal against the various tests. Caterers should also ask their supplier about the process and checks they have in place to ensure compliance against IDDSI.”

What this has meant for suppliers of dysphagia meals - so, for instance, is it just a re-packaging/labelling exercise or has it been necessary to go back to basics and reformulate/restructure the entire range?

The introduction of IDDSI has created the need for suppliers to amend product ranges to be compliant with the new guidelines. As a result, at apetito, teams of dedicated chefs, dietitians and nutritionists have taken texture modified meals through a redevelopment process to change the viscosity of meals, the thickness of sauces, plus vigorous regeneration trials to prevent meals forming a skin or crust when cooked. Due to the sizing guidelines for levels 5 and 6, suppliers have had to redevelop these meals to meet requirements. For this, sourcing of new ingredients and finding new suppliers has been necessary.

Further to changes to the meals themselves, suppliers have changed their internal processes. Kelly describes the additional measures put in place to ensure food is compliant, “To prepare for the implementation of IDDSI, we trained all our key teams on the new framework, plus added additional checks into the manufacturing process to ensure safety.”

Does it affect the nutritional values of the meal?

IDDSI aims to provide improved nutrition and safety for dysphagia patients. As pre-prepared texture modified foods are created to meet dietary and nutritional requirements set by governing bodies such as the British Dietetic Association, IDDSI will not affect the nutritional value of meals bought from suppliers. Helen says, “In theory, IDDSI shouldn’t change the nutritional values of a meal at all. However, if you are altering a texture incorrectly, by adding water instead of liquids such as milk or gravy, or other fluids with added nutritional value, you could affect the nutrition levels. From an apetito point of view, the changes made to the meals will not have affected the nutrition unless the product has been changed considerably.”


If the caterer is buying in its dysphagia meals, what should it now look for from its suppliers to be sure that the meals meet the new framework?

With the changeover to IDDSI, suppliers will no longer be using the national texture descriptors. Caterers should be familiar with and be looking out for the new terminology, this includes the new names that include; liquidised, pureed, minced & moist and soft & bite sized. Caterers should also lookout for a slight change in how products are now labelled, for example, letters were previously used (Category B, C, D and E) which is now becoming numbers (Levels 3, 4, 5 and 6). Helen describes how caterers will be able to recognise IDDSI compliance in apetito food, “We are going for a triple label approach – we’ve included on our label the new level in terms of a number, but also the level it is in terms of the terminology and we are also using the colour pantones in a triangle assigned to each level which is the visual outline that IDDSI use.”