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IDDSI: The International Dysphagia Diet Standardisation Initiative framework

The International Dysphagia Diet Standardisation Initiative (IDDSI) have published international standardised terminology and definitions for texture modified foods and thickened liquids for people with dysphagia. 

The framework consists of a continuum of eight levels (0-7) a plus one sub-level to Level 7 called Easy to Chew. It includes descriptors, testing methods and evidence for both liquid thickness and food texture levels. 

Benefits of IDDSI

a) The framework has been developed after much research and collaboration across the world and each level is based on evidence.

b) The framework is a continuum and contains levels for fluids as well as foods. This means that the safety of patients when both eating and drinking is accounted for and assured. 

c) The framework has been adopted across the world e.g. and countries such as the USA, Australia, Canada, New Zealand, Germany and Austria. Many other countries are in the process of adopting the IDDSI framework. This means that when healthcare workers and patients travel from country to country there will be no confusion about the dysphagia descriptors being used and this in turn means that patient safety is assured.

d) Because many countries use the same descriptors there is a greater ability for researchers to do larger research studies and systematic reviews. This means that we will be able to generate more robust evidence about the care of patients with dysphagia.

e) The final benefit of implementing the framework is that it gives professionals the opportunity to raise the profile of the care of patients with dysphagia. It also encourages multidisciplinary working and raises the profile of both nutrition, patient safety and dietitians.

How was the IDDSI framework implemented?

In 2015 a UK wide Expert Reference Group (ERG) was set up to decide whether to adopt the IDDSI framework. The group comprised: BDA, RCSLT, dietitians from England, Wales, Northern Ireland, and Scotland, representatives from nursing homes, HCA, NACC, BSNA, manufacturers of thickening agents and products designed specifically for people with dysphagia and manufacturers of modified texture pre-prepared meals.

The group spent over a year gathering evidence to determine whether or not to adopt the framework and this work has included literature reviews, pilots, a pros and cons exercise and surveys of healthcare professionals. In August 2017, the BDA surveyed dietitians to find out their views on the possible adoption of IDDSI and the RCSLT did a similar exercise with its membership.

Following the comprehensive analysis of this evidence, the results were presented to the BDA and RCSLT. Both the RCSLT and BDA independently announced that they supported the adoption of the framework. 

Letter of confirmation of the BDA's adoption of the framework

The BDA and RCSLT saw the adoption of the framework as of great benefit to patients and carers alike for the following reasons:

Improvement of patient safety

  • Improvement of patient experience - they are less likely to choke and /or aspirate when eating and drinking.
  • Improvement of patient nutrition and hydration as a result of the above two factors.
  • Greater opportunities to collect and evaluate treatment outcomes (due to international standardised terminologies, larger cohorts of patients can be compared in research to evaluate the effects of existing and new treatments).
  • The combination, within one framework or continuum, of descriptors for both texture modified food and fluids.

Implementation of the IDDSI framework

NHS Improvement issued a Patient Safety Alert in June 2018 that required all NHS trusts across the UK to both avoid using the term 'soft diet' (which is non specific and its use had been associated with serious incidents and several deaths due to choking) and implement the IDDS framework.

Implementation Toolkit

The UK Expert Reference group has developed an implementation toolkit to assist healthcare professionals to implement the framework safely and efficiently in their local settings.

The toolkit (below) is being added to in real time and so do check this webpage regularly to find any new items.

The toolkit comprises:

The IDDSI website has a number of resources that local implementation teams may find useful including: 

  • published research articles
  • reports
  • posters
  • a general FAQ section
  • Information about drink and food testing methods with accompanying videos are available.

Keep up-to-date with the latest developments

There is a monthly e-newsletter providing the latest information about the Framework. To receive the latest news please subscribe here.

If you have any questions directly related to the Framework, please contact IDDSI.