The International Dysphagia Diet Standardisation Initiative (IDDSI): A global language for people with dysphagia

Thank you to Sukhi Aujla (@sukhpreet_aujla) for producing the latest #ResNetSLT blog post.

The Tweetchat on July 25th, 2018, focused on the implications of the United Kingdom adopting the standardised terminology agreed by the International Dysphagia Diet Standardisation Initiative (IDDSI) committee for texture modified foods and thickened liquids.

Clinicians agreed on the importance and timeliness of IDDSI. The recent NHS Improvement (NHSi) Patient Safety Alert (June 27th, 2018) detailed a review of the National Reporting and Learning System (NRLS) incidents over a two-year period.

They identified seven incidents where patients appear to have come to significant harm because of confusion over the meaning of 'soft diet'.

Inconsistency in labels used for diet and fluid modifications can therefore be linked to episodes of patient ill-health or death. Three years of ongoing work by the IDDSI Committee has culminated in a final framework consisting of a continuum of eight levels (0-7) spanning food and fluid.

Each level is identified by numbers, text labels and colour codes, and contains a technical description and objective testing method. The framework was developed by a multi-professional group following a rigorous process of reviewing existing national terminologies, a systematic review of research literature, and a survey of more than 5,000 international stakeholders.

The IDDSI committee has also highlighted the urgent need for further research for example, determining fluid thickness levels that provide therapeutic benefit by reducing risk for penetration and aspiration and/or improving swallow function.

There are a number of current and planned research studies. When working with people with dysphagia, the need to speak the same 'language' across all health, social and residential care settings is clear. RCSLT and NHSi have recommended that all healthcare settings are IDDSI compliant by April 1st, 2019.

The implementation of IDDSI presents a significant challenge for all SLTs working with people with dysphagia, and a real life example of the complexities of translating research into clinical practice. 

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