Developments on the International Dysphagia Diet Standardisation Initiative, IDDSI

Transcription

1 Developments on the International Dysphagia Diet Standardisation Initiative, IDDSI Dr Ben Hanson, University College London UCL 1. Where we are now timeline and what s happening 2. IDDSI: What? and Why? 3. Recent news

2 IDDSI UK timeline

3 IDDSI UK now APRIL 2018 APRIL 2019 Healthcare professionals lead local implementation from April 2018 IDDSI compliant products, foods and labels start to become available from April 2018 All manufacturers and health care settings are fully IDDSI compliant by April 2019

4 IDDSI now

5 IDDSI now

6 IDDSI now Alert reference number: Pat ient Saf et y Alert NHS/PSA/RE/2018/004 Resource Alert Dysphagia u is the medical term for swallowing difficl ties and a si gn or symp t om of disease, which may be neurological, muscular, physiological or structural. Dysphagia affects people of all ages in all types of care setting. 1 Food texture a modifict ion iswi del y accept ed as a wa y to ma nage dysphagi a. 1 Terms for flud thi ckeni ng, such as custar d thickness, have varied locally and numerical scales have been used by industry. National standard terminology d for modifie food text ur e, including terms such as fork-mashable, 2 was agreed in 2011 and widely adopted by the hospital catering industry i and many clinical settings. However, local variations have persisted for both food and flud text ur e, confusing patients, carers and healthcare staff. The imprecise term soft diet continues to be used to refer to the modifie food text ur e required by patients with dysphagia, and others without dysphagia, for example, with lost dentures, jaw surgery, frailty or impulsive eating. A review of National Reporting and Learning System (NRLS) incidents over d a recent two-year period identifie seven r eports where patients appear a to have come to significnt har m because of conf usi on about the me ani ng of the ter m soft diet. These incidents included choking requiring an emergency team response, and aspiration pneumonia; two patients died. An example incident reads: Patient with documented dysphagia given soft diet including mince and peas at lunch unresponsive u episode. Difficl ty vent ilat ing pat ient over night. Peas [suctioned out via] endotracheal tube. Around 270 similar incidents reported no harm or low harm such as coughing or a brief d choking episode. These incidents suggest the continuing widespread use of the term soft diet can lead to patients needing a particular type of modifie di et bei ng har me d. The International Dysphagia Diet Standardisation Initiative (IDDSI) has developed a standard terminology a with a colour and numerical index to describe texture modifict ion for food and dr ink. 3 Manufacturers will be changing their labelling and instructions accordingly, and aim to complete this by April Transition from the current range of food and drink texture descriptors to IDDSI framework for people with dysphagia needs careful local planning to ensure it happens as soon and as safely as possible. For practical reasons and to reduce the risk of errors, IDDSI food texture descriptors also need to d be adopted for patients who do not have dysphagia but for other clinical reasons need a modifie text ur e diet equivalent to IDDSI levels 6 to 4 (usually in the short-term). IDDSI point out that within a regular (level 7) diet there are many easier to chew options and these may be suitable for some of these patients. 4 The needs of non-dysphagia patients should be noted in care Resources a to support safer modifict i on of food and drink 27 June 2018 Act ions Who: All organisations providing NHS funded-care for patients who have dysphagia or need the texture of their diet modifie for ot her reasons, including acute, mental health and learning disabilities trusts, community services, general practices* and community pharmacies* When: To start immediately and be completed by 1 April Identify a senior clinical leader who will bring together key individuals (including speech and language therapists, dietitians, nurses, medical staff, pharmacists and catering services) to plan and co-ordinate safe and effective local transition to the IDDSI framework and eliminate use of imprecise terminology including soft diet Develop a local implementation plan, including revising systems for ordering diets, local training, clinical procedures and protocols, and patient information Through a local communications strategy (eg newsletters, local awareness campaigns etc) ensure that all relevant staff are aware of relevant IDDSI resources and importance of eliminating imprecise terminology including soft diet, and understand their role in the local implementation plan *Community pharmacy services and general prac-

7 What is IDDSI? Published 1 in November Global standardised framework that provides terminology and definitions for texture modified foods and thickened liquids A continuum of 8 levels (0-7) Colour-coded Culturally-neutral Includes descriptors, testing methods and evidence for both drink thickness and food texture levels 1 Cichero, J.A.Y., Lam, P., Steele, C.M. et al. Dysphagia (2017) 32: 293.

8 Why IDDSI? Let s be specific Subjective, estimated The categories are not clearly defined. Naturally Thick Leaves a coating on an empty glass 1 Leaves a thin coat on the back of a spoon 3 Needs to be taken with a spoon 2 Leaves a thick coat on the back of a spoon

9 Descriptors are subjective Brand A Both were described as stage 1 Brand B Are they equivalent?

10 IDDSI is objective A flow test has been used to define levels 10

11 IDDSI is objective A flow test has been used to define levels 10

12 LIQUIDS: from National Descriptors to IDDSI Subjective, estimated Objective, measured 3 The categories were not clearly defined. Needs to be taken with a spoon The IDDSI Levels are defined by measurement using the flow test for Levels 0-3 and the spoon/fork tests for Level ml 2 1 Nat. Thick Leaves a thick coat on the back of a spoon Leaves a thin coat on the back of a spoon Leaves a coating on an empty glass The descriptors broadly match the IDDSI levels 0-4. But descriptors are subjective, not specific. 8 ml 4 ml 1ml Thin

13 FOODS: From UK National Descriptors to IDDSI Subjective Some criteria were not specifically defined.

14 FOODS: From UK National Descriptors to IDDSI Textures B to E map to IDDSI Levels 3 to 6 after adding detail and measurement Fork Mashable Define how soft. Limit size of lumps to reduce choking risk (15mm adults / 8mm children) Pre- Mashed Define moistness and particle size (4mm adults / 2mm children) Thick Purée Define moistness and cohesiveness Thin Purée Define flow properties (IDDSI flow test)

15 February 2018 Used with permission from IDDSI Example: Bite-sized pieces of 1.5 x 1.5cm for adults (about the size of an adult thumb nail) 8mm x 8mm for children Chewing is necessary Tongue strength and control needed to move food for chewing and for swallowing Should be able to easily cut this texture with just the side of a fork Press into a bite-sized piece of food with your thumb in the bowl of a fork hard enough that the thumbnail turns white The food should squash easily and not return to its original shape

16 IDDSI BREAKING NEWS Syringes / funnels: getting the right tool for the job ! Check 10 website and newsletters for examples of correct syringes Contact Nutricia if you need help with finding a syringe Purpose-made funnels to follow IDDSI Soft [but not necessarily served in 'bite- 10 sized' pieces] Many settings require a soft diet for people without dysphagia. We re consulting 10

17 IDDSI resources

18 UK IDDSI resources

19 Take IDDSI with you: Free apps to download

20 Developments on the International Dysphagia Diet Standardisation Initiative, IDDSI Dr Ben Hanson, University College London UCL 1. Where we are now timeline and what s happening 2. IDDSI: What? and Why? 3. Recent news