IDDSI Training in Canada: A Practical Guide for Long-Term Care & Foodservice Teams
IDDSI Training Canada is increasingly relevant for long-term care, continuing care, dietary and foodservice teams supporting people with swallowing difficulties. Clear communication, consistency and an understanding of each person’s individual eating and drinking recommendations are essential. For staff working in long-term care, continuing care, residential care, dietary services and foodservice across Canada, the International Dysphagia Diet Standardisation Initiative — commonly known as IDDSI — provides standardised terminology for describing texture-modified foods and thickened liquids. But what exactly is IDDSI? How is the framework relevant in Canada? And what should care, dietary and foodservice teams understand when supporting someone with dysphagia? This practical guide introduces dysphagia and the IDDSI Framework, explains the importance of standardised terminology and looks at some of the practical considerations for Canadian long-term care and foodservice teams. Looking for flexible online training? FlexiLearnHub provides online Dysphagia Awareness & IDDSI Framework Training for individual learners and organisations across Canada. Explore IDDSI Training Canada What Is Dysphagia? Dysphagia is the medical term for difficulty swallowing. Swallowing difficulties can affect a person’s ability to manage food, drinks, saliva or medication. The nature and severity of dysphagia can vary considerably between individuals. For some people, an appropriate assessment may result in recommendations concerning food texture, drink thickness or other strategies related to eating and drinking. This is why dysphagia should not be treated simply as a catering issue. Assessment and management require appropriate professional input, while care, dietary and foodservice staff need the knowledge relevant to their own responsibilities. Awareness training can help staff understand terminology, recognise the importance of individual recommendations and appreciate why accurate communication between different members of the team matters. What Is the IDDSI Framework? The International Dysphagia Diet Standardisation Initiative (IDDSI) developed a global framework for describing texture-modified foods and thickened liquids used for people with feeding, chewing or swallowing difficulties. The framework consists of eight levels, numbered 0–7. These cover drinks of different thicknesses and foods with different texture characteristics. The purpose is to provide common terminology and definitions that can be understood across professions and care settings. IDDSI also provides testing methods that help determine whether foods and drinks have the characteristics associated with particular levels. The current official IDDSI Framework and Detailed Level Definitions is Version 2.2, while the current IDDSI Testing Methods is Version 2.0. For the latest documentation, always refer to: Official IDDSI Framework Documents Is IDDSI Used in Canada? Yes. IDDSI has an established history in Canada. The Canadian IDDSI Expert Reference Group reported that IDDSI was launched in Canada in January 2019, with work subsequently undertaken to support Canada-wide implementation. Dietitians of Canada has also publicly supported IDDSI and highlighted the potential benefits of standardised terminology for communication between professionals and facility staff. Importantly, however, IDDSI should not be presented as though the framework itself replaces individual assessment or determines what every person with dysphagia should receive. Dietitians of Canada’s long-term-care work has noted both the potential value of standardisation and the importance of individualising texture modification according to a resident’s needs and changing abilities. That distinction is important. IDDSI provides a common framework for describing food textures and drink thicknesses. The appropriate recommendations for an individual should still arise from appropriate assessment and professional decision-making. Why IDDSI Awareness Matters in Canadian Long-Term Care When considering IDDSI Training Canada, it is important to distinguish between awareness-level education and clinical dysphagia competency. A resident may receive support from several different professionals and departments. Depending upon the individual and setting, these might include: Speech-language pathologists Dietitians Nurses Care and support staff Dietary services Foodservice managers Cooks and kitchen staff Other members of the interdisciplinary team Each role is different, but information about an individual’s eating and drinking requirements may need to move accurately between several members of that team. Dietitians of Canada has identified inconsistent communication of diet orders or food and fluid texture modifications as a potential source of unintended errors in care. Its statement supporting IDDSI recognised the potential of common terminology to improve communication within and across care teams. For long-term-care organisations, this makes staff awareness important. Not everyone needs clinical expertise in dysphagia, but relevant staff should understand the terminology and responsibilities appropriate to their role. Understanding Texture-Modified Foods Some people with dysphagia may have recommendations for foods with particular texture characteristics. The IDDSI Framework includes food descriptions such as Pureed, Minced & Moist, Soft & Bite-Sized and Easy to Chew. These are not simply informal descriptions. Each level has defined characteristics and relevant testing methods. For dietary and foodservice teams, this means a food should not be assumed to meet a required texture merely because it appears soft, has been mashed or has been processed in a blender. Equally, staff should not decide independently that somebody requires a particular IDDSI level simply because that person has dysphagia. The person’s individual assessment, documented recommendations and organisational procedures should guide practice. For more practical information about texture modification, see: What Are Texture-Modified Meals? Texture-Modified Food and Quality of Life Texture modification involves more than achieving a particular physical consistency. Food is also connected with nutrition, enjoyment, choice, culture, dignity and quality of life. This is particularly important in long-term care, where residents may receive most or all of their meals from the organisation providing their care. Canadian long-term-care research and guidance have recognised some of the practical challenges surrounding texture-modified diets, including food production, resident acceptance, nutritional status and satisfaction. That reinforces an important principle: standardisation of terminology should sit alongside individualised and person-centred care. For cooks and foodservice teams, presentation and palatability therefore remain important even when a meal needs to meet particular texture requirements. For those interested specifically in improving Level 4 meal presentation, FlexiLearnHub also provides: Advanced IDDSI Level 4 Purée Presentation Understanding Thickened Liquids The IDDSI Framework also provides standardised terminology for drinks of different thicknesses. Where an individual has a documented recommendation for a particular drink thickness, relevant staff need to understand that requirement and follow the appropriate procedures. Standardised terminology