T H E N E W I N T E R N A T I O N A L D Y S P H A G I A D I E T S TA N D A R D I Z A T I O N I N I T I A T I V E

IDDSI? T H E N E W I N T E R N A T I O N A L D Y S P H A G I A D I E T S TA N D A R D I Z A T I O N I N I T I A T I V E P R E S E N T E R : S A R A B R O W N I N G, M S, R D N, C D

DISCLOSURE SARA BROWNING Serves as the Outpatient Clinical Nutrition Manager for Primary Children s Hospital, Intermountain Healthcare Previously served as the Patient Care Manager at Primary Children s Hospital, with responsibilities over patient room service, and formula systems Receives no compensation for educating about IDDSI No affiliations outside of Intermountain Healthcare

DYSPHAGIA: THE BASICS 8% of the world population 590 million people worldwide living with dysphagia 1 in 25 adults with dysphagia 1/3 develop pneumonia, 60,000 die 25% - 45% of children Cicero, Julie, 2013 IDDSI Report http://www.asha.org/prpspecifictopic.aspx?folderid=8589942550&section=incidence_and_prevalence

DYSPHAGIA: THE BASICS History of Dysphagia Little thought given to look of food Foods thickened with other foods Pureed and baby foods were the norm No standards

DYSPHAGIA: THE BASICS NDD GUIDELINES Dysphagiga Guidelines NDD National Dysphagia Diet Levels Established in 2002 Aim to establish standard terminology and practice applications Thickened Liquids Levels not included Doesn t address pediatrics http://leader.pubs.asha.org/article.aspx?articleid=2292328

THE BASICS Type of Dysphagia Oral dysphagia refers to difficulty in the passage of liquids or food from the mouth to the esophagus. Pharyngeal dysphagia refers to difficulty with the passage of food through the pharynx to the esophagus. Stages of Dysphagia Oral Phase Pharyngeal Phase Esophageal Phase http://www.ialp.info/faqs%20from%20the%20dysphagia%20committee http://www.asha.org/public/speech/swallowing/feeding-and-swallowing-disorders-in-children/

THE BASICS Causes of Dysphagia Pediatrics prematurity, cleft lip, nervous system disorders Adults Stroke, head or neck cancer, Parkinson's Diagnosis of Dysphagia Flexible endoscopic Evaluation Conducted by ENT and Speech Therapy Less common, used if vocal chord concerns Clinical Feeding Evaluation Conducted by Speech Therapy Modified barium swallow study Administered by a Radiologist and Speech Therapy Treatment of Dysphagia Medical intervention Direct feeding therapy Nutrition changes Behavior management http://www.ialp.info/faqs%20from%20the%20dysphagia%20committee http://www.asha.org/public/speech/swallowing/feeding-and-swallowing-disorders-in-children/

WHAT DOES A DIETITIAN DO? Food Services Menu/Recipe preparation Accuracy verification Tech education Multidisciplinary collaboration Medical Nutrition Therapy Treated through a team approach Team may include Occupational therapist Physical therapist Physician and/or nurse Dietitian Developmental Specialist

The IDDSI Board is a team of volunteers, consisting of dietitians, speech pathologists, food scientists, physicians, occupational therapists, engineers, nurses, and professionals who have come together to help create the IDDSI framework.

IDDSI OVERVIEW Background Names, the number of levels of modification, and characteristics vary within and across countries Objectives Standardized way of naming and describing texture modified foods and thickened liquids Person-focused, rather than profession focused. Global terminology that will work for all cultures Common language that can be used for technical, cultural, professional and nonprofessional uses. Academy & ASHA Acceptance Press Release January 2017 http://iddsi.org/about-us/

IDDSI & NDD IDDSI NDD Regular Diet NDD3 Advanced NDD2 Mechanical Soft NDD1 Pureed Spoon/Pudding Thick Honey Like Nectar Like Half Nectar

IDDSI IN PRACTICE Liquid Testing Methods - Testing Viscosity Materials 10 ml slip tip syringes Stop watch Method Stop the syringe and fill with 10 ml of liquid For 10 seconds, allow the liquid to flow Note the liquid level http://iddsi.org/framework/drink-testing-methods/

IDDSI IN PRACTICE Food Testing Methods - Testing Consistency Method Fork Drip Test Fork Pressure Test Chopstick Test Finger Test Test to develop recipes Don t test every time http://iddsi.org/framework/food-testing-methods/

IDDSI IN PRACTICE Menu Tips & Tricks Keep It Simple Use What You Already Have Use Ready Made Products Know Your Audience

IDDSI IN PRACTICE Making the Switch Food particles will be smaller Peds lump sizes differ from adults Pepper is back Buy a blender Excess fluid must be drained

IDDSI IN PRACTICE Improving the patient experience Goal is always to find the least restrictive food modification Visual appeal is half the battle

LET S PRACTICE Scenario 1 70 year old patient Speech therapy recommends Level 4 Patient wants something hot and savory Task Develop an appropriate meal What testing method should you use to verify safety?

LET S PRACTICE Scenario 2 6 year old patient Speech therapy recommends Level 5 Patient wants dry cheerios to eat Task Is this safe as a transitional food? What test should you use to verify safety?

INTERMOUNTAIN IMPLEMENTATION System Wide Roll-Out Project Leader Paul Osborne Phase 1- Preparation Benchmark process Expected 200-300 hours or work Phase II Roll Out icentra Order Rebuild Computrition Reconfigure

RESOURCES IDDSI.org Generalmillscf.com Dysphagia Cookbooks US Foods

REFERENCES Agency for Health Care Policy and Research (AHCPR). (1999). Diagnosis and treatment of swallowing disorders (dysphagia) in acutecare stroke patients [Evidence Report/Technology Assessment No. 8, AHCPR Publication No. 99-E024]. Rockville, MD. Arvedson, J. C. (2008). Assessment of pediatric dysphagia and feeding disorders: Clinical and instrumental approaches. Developmental Disabilities Research Reviews, 14, 118-127. Feeding and Swallowing Disorders in Children. American Speech Language Hearing Association, 2017 http://www.asha.org/public/speech/swallowing/feeding-and-swallowing-disorders-in-children/. Accessed August 20, 2017. Bhattacharyya, N. (2014). The prevalence of dysphagia among adults in the United States. Otolaryngology Head and Neck Surgery, 151, 765 769. Complete IDDSI Framework Detailed Definitions: International Dysphagia Diet Standardization Initiative. 2017. Cichero, Julie. 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. vol 1. Dec 2013. p 280-291 Academy of Nutrition and Dietetics, American Speech-Language-Hearing Association Support New Global Standardization of Diets for Swallowing Disorders. Academy of Nutrition and Dietetics. 2017. Lam, Peter et al. International Dysphagia DietStandardisation Initiative: Categoriztion Framework, Labels and Terminology. The IDDSI Committee. 2015. The http://iddsi.org/wp-content/uploads/2016/05/iddsi-essd-poster-september-2015.pdf Accessed August 20, 2017.

sara.browning@imail.o rg