5 Steps for Hospital Dietitians to Implement IDDSI in a Streamlined Way

If you’re a hospital dietitian or dietary manager, you’re likely familiar with IDDSI, or the International Dysphagia Diet Standardisation Initiative.

Launched in the United States in 2019, IDDSI is a standard for serving texture-modified foods and thickened liquids to individuals with chewing and swallowing problems.

An estimated 560 million people around the world experience these challenges. The ultimate goal of IDDSI is to help keep patients with chewing and swallowing problems safe.

Organizations have been adopting IDDSI on a wider scale since October 2021, when the Academy of Nutrition and Dietetics recognized IDDSI as the only texture-modified diet in the Nutrition Care Manual, or NCM®.

As IDDSI becomes more prevalent, hospital dietitians and dietary managers are ready to start implementation. Speech-language pathologists and decision-makers at hospitals across the U.S. also support IDDSI adoption.

But, IDDSI has many moving parts — and that can create roadblocks for those leading the charge.

Hospital dietitians need easy-to-follow instructions on adopting IDDSI in the hospital setting. This five-step checklist will help you implement it in a streamlined way.

This guide will help you clarify what’s needed, simplify your processes, and empower your organization’s staff to put the standards into practice.

Here are the steps to making IDDSI a reality in your institution:

             1. Form an interdisciplinary IDDSI implementation team in your hospital.

            2. Complete one-time IDDSI implementation projects.

            3. Create recipes and menus for your hospital’s IDDSI levels.

            4. Train your hospital colleagues on IDDSI implementation.

            5. Develop IDDSI safety culture in your hospital.

 Let's begin with the first step of gathering internal support.

1. Form an interdisciplinary IDDSI implementation team in your hospital.

             Key action steps:

•              Gather an IDDSI implementation team from multiple departments.

•              Enlist an IDDSI champion.

•              Educate the team on IDDSI.

The first step to implementing IDDSI in your hospital is gathering an IDDSI implementation team. This group will help you operationalize IDDSI across your institution.

IDDSI is an interdisciplinary endeavor, so you’ll need team members from several departments. At the minimum, recruit colleagues from these teams:       

•             Administration

•             Nursing

•             Speech-language pathology

•             Clinical dietitian

•             Foodservice dietitian

The most vital part of creating an IDDSI implementation team is enlisting an IDDSI champion.

The champion helps move along the implementation process. They help you open up inevitable roadblocks that come up and ”rally the troops” when the team faces challenges.

“Your IDDSI champion is hopefully someone in an administrative role who has influence over all these other disciplines and cares about patient safety and quality for texture-modified foods,” said Margaret Roche, founder of Roche Dietitians.

 Before you mobilize the IDDSI implementation team, make sure they’re up to date on what IDDSI is. If not, educate the group using an IDDSI training program.

READ MORE: Your Ultimate Guide to IDDSI

 2. Complete one-time IDDSI implementation projects.

             Key action steps:

•              Prioritize completing one-time IDDSI implementation projects.

•              Decide which IDDSI levels you’ll serve.

•              Standardize and switch your diet orders.

•              Change diet orders within electronic health records.

•              Update diet orders within policies and processes.

 Now that you’ve gathered the IDDSI implementation team and identified your champion, you can start putting IDDSI into action.

 Several aspects of implementation are ongoing, but we recommend beginning with the four projects you’ll do once.

 Tackling projects in the optimal order will streamline implementation. Plus, checking off these one-time tasks will give you momentum at the beginning of the process.

 

Here’s the breakdown of the four one-time projects:

Decide which IDDSI levels you’ll serve in your hospital.

IDDSI can be overwhelming because hospital dietitians sometimes feel they need to serve all IDDSI levels right away. You don't have to serve all IDDSI levels from the outset.

Take each level one step at a time. We recommend starting with Pureed (Level 4) since most hospital dietitians are already making purees.

 Your purees may not be up to the IDDSI standards yet, but that’s okay. You’ll just need to evaluate your purees and adjust them to meet the IDDSI standards. A fork and spoon are the only tools you’ll use to assess them.

Once your purees are ready to go, you can move to Minced & Moist (Level 5). Next, if you decide to serve more levels, you can focus on Soft & Bite-Sized (Level 6) and Regular Easy to Chew (Level 7).

Standardize and switch your diet orders.

Consistent diet terminology and standardized diet definitions are core benefits of IDDSI.

Standardizing and switching your diet orders is integral to the implementation process. The IDDSI framework shows the standardized diet name, color, and abbreviation for each level. You’ll switch out old language for the new standardized terminology wherever it appears.

Communicating this consistent terminology will reduce confusion moving forward. Placing IDDSI posters in your kitchen will also reinforce these standards.

Change diet orders within electronic health records.

Now that you’ve standardized your diet orders, you’ll need to change them within your hospital’s electronic health records. Coordinate with your IT department or whoever works with electronic health records.

Updating records helps ensure consistent diet order communication. The record should be consistent with official IDDSI terminology.

Update diet orders within policies and processes.

Update diet orders within policies and processes to streamline communication. Any relevant policies should reflect the diet orders you serve. Revise policies that have diet order language, including diet manual, meal preparation, meal transportation, and meal delivery policies.

Other disciplines like nursing and speech-language pathology will need to update policies and forms to reflect the new IDDSI terminology. 

You’ll also develop new policies on the ongoing IDDSI training you’ll administer to your colleagues. We’ll talk more about ongoing training in Section Four: Train your hospital colleagues on IDDSI implementation.

READ MORE: IDDSI? An Expert Dietitian Gets You Started

3. Create recipes and menus for your hospital’s IDDSI levels.

             Key action steps:   

•             Take note of the value of a chef-dietitian partnership.

•             Partner with a chef to develop recipes.

•             Use the IDDSI testing methods to test and evolve your recipes on an ongoing basis.

Now that you’ve finished one-time projects, you can dive into the nitty-gritty of IDDSI implementation: recipes and menus.

 While it might be tempting to develop them on your own, enlist the help of your organization’s chefs and culinary team. Getting IDDSI recipes right is a challenge from both a culinary and dietetic perspective, so you’ll need both sets of expertise in the test kitchen.

 “IDDSI requires the best of what a registered dietitian has to offer and the best of what a chef has to offer. It’s very powerful what the chef-dietitian partnership can achieve together,” said Roche.

 A chef’s attention to taste and appearance complements a dietitian’s emphasis on nutritional value. An appealing plate encourages patients to eat more — which in turn helps their nutrition.

 When chefs and dietitians team up, one plus one equals three. The collaboration helps elevate both food quality and patient safety.

 One of the best-kept IDDSI implementation secrets is the power of the chef-dietitian partnership. The joint effort helps improve your patients’ safety and enjoyment at mealtime.

 How do you create IDDSI recipes? Here’s a step-by-step approach

• Recruit a chef to partner with you. Make sure they are fully trained in IDDSI characteristics and testing methods for each IDDSI level.

•  Start developing a few recipes together.

•  Use the IDDSI testing methods to test and evolve your sample recipes.

• Develop a template for similar recipes. For example, all braised beef recipes will have a similar method of preparation for SB6. While all cooked tender vegetables will have a similar method of preparation for MM5.

• Build out your recipes in categories using your templates.

•  Choose the final recipes you’ll use in your menus.

•  Continue collaborating on new recipes as fresh inspiration strikes.

If you need help building IDDSI menus and recipes, our team of dietitians is here to assist you. We can help you plan IDDSI-compliant menus and craft recipes that meet the IDDSI standards and fulfill your patients’ unique needs.

READ MORE: How Dysphagia Chefs and Dietitians Around the World Are Teaming Up to Tackle IDDSI

 

 4. Train your hospital colleagues on IDDSI implementation.

Key action steps:

• Make a list of the order in which you'll train your colleagues: (1) IDDSI implementation team, (2) food service team, and (3) non-foodservice workers involved in patient feeding.

• Select a plug-and-play IDDSI training program [link to hospital landing page] with the five key components of a high-quality program.

• Commit to providing ongoing instruction.

At this point, you’ve finished the behind-the-scenes work of implementing IDDSI. Now, you can expand your reach.

The next step is training your colleagues on IDDSI. This step has the greatest influence on helping improve your organization’s food safety and quality.

You’ll start with filling any knowledge gaps among the IDDSI implementation team. Next, you’ll train the foodservice team.

We recommend training non-foodservice workers involved in patient feeding. This group includes speech-language pathologists, occupational therapists, physical therapists, nurses, and CNAs.

Training everyone across many disciplines is a substantial undertaking, but it’s worth it. The instruction will empower them to carry out IDDSI and help keep your patients safe. This empowerment is especially important for foodservice teams because they play a critical role in testing.

The kitchen is your IDDSI headquarters. So, equipping foodservice teams with in-depth testing knowledge is vital. These new testing methods, like the fork drip test, spoon tilt test, and fork pressure test, call for a thorough education.

 “Because of the safety and quality needs, you can’t skip training — and you especially have to get it right,” said Roche.

How do you identify the right solution? Choose an IDDSI training program with these five key components. The training should:

•  Teach IDDSI in a thorough, clear, and organized way.

•  Focus only on what your team needs.

•  Empower multiple types of learners.

•  Foster independent problem-solving.

•  Promote a culture of safety.

A system with these five elements will put you on the path to IDDSI success. Unlike step two, though, IDDSI education is not a one-and-done project — it’s an ongoing process.

We believe administering ongoing training is the biggest hurdle to implementing IDDSI.

Training is ongoing because educating colleagues from many disciplines will take time. The high turnover rate in foodservice also impacts the process. You may train the foodservice team, and then six weeks later, your organization hires a new staff member.

If you’re a dietitian in a large hospital system, the need for ongoing training is even greater. Many systems have a rehabilitation hospital and behavioral health hospital, plus physical therapy, occupational therapy, and long-term care units. Some dietitians even oversee a multi-state system with dozens of facilities.

Of course, this is stressful. It might tempt you to push IDDSI to the bottom of your list. But you can make it happen because you don't have to create the training yourself.

A plug-and-play IDDSI training program for hospital dietitians

We saw the hurdles hospital dietitians encounter with developing IDDSI education. So we created plug-and-play IDDSI training resources.

The Roche Dietitians’ “We Test For Safety” IDDSI Training Program will equip your institution's staff to put IDDSI into action.

We recommend the Complete IDDSI Training Bundle for training on all IDDSI food levels with easy-to-follow instruction and hands-on learning experiences. 

Think of it as a one-stop-shop. You don’t have to develop any training material.

Right away, your colleagues will have every piece of information they need to carry out IDDSI, with an emphasis on testing methods.

And in 30 days, you’ll be on the path to educating the entire foodservice team on IDDSI levels four through seven.

Our training fulfills the five key components of a high-quality system. We’ve spent hundreds of hours creating it, including:

• Taking photos of the testing methods

• Developing the content

• Writing the scripts

• Fact-checking the material

• Filming and editing the videos

• Uploading the program to our hosting platform

Developing materials on your own would be a massive hurdle. Most hospital dietitians don't have the time it requires. Plus, our courses are highly detailed. Building an in-depth program is virtually impossible for dietitians with ever-expanding to-do lists.

Our courses are ideal for ongoing training because you can access the content for one year. They’re an excellent fit for dietitians who oversee many hospitals, as well as dietitians who work for a single hospital. We offer discounts and custom set-ups to corporate buyers with greater than two units.

The deeply researched courses work for both foodservice and non-foodservice workers. We can customize the program to fit your learning management system.

Plus, you don’t have to navigate the training on your own.

Bottom line: you need a ready-made training system, and you need it to be good. Our program exists to fill in the gap for you.

The Complete IDDSI Training Bundle will equip you to carry out IDDSI training from start to finish. The bundle comes with courses on Pureed (Level 4), Minced & Moist (Level 5), Soft & Bite-Sized (Level 6), and Regular Easy-to-Chew (Level 7), plus an Introduction to IDDSI course.

Imagine being off and running with IDDSI education one month from now. You've helped improve food safety and quality. You’re closer to meeting the standard of practice.

Today, it might feel impossible to make IDDSI a reality in your hospital. But with the help of expert resources and a supportive community, you can do it.

READ MORE: The Five Key Components You Need to Train Foodservice Workers on IDDSI

5. Develop IDDSI safety culture in your hospital.

            Key action steps:

•            Embrace IDDSI safety culture as a way to integrate IDDSI into your institution.

•            Focus on developing a new group culture around IDDSI, rather than relaying IDDSI information.

•            Use IDDSI posters and a comprehensive IDDSI training program to emphasize a safety mindset among employees.

•            Prioritize developing a safety culture in your overall patient safety program.

By now, you’ve checked off steps one through four of IDDSI implementation. You’ve formed a team. You’ve completed the one-time projects. You’ve created recipes and menus. And you’ve trained your colleagues on IDDSI.

It’s time for the final step: developing what we call “IDDSI safety culture.”

IDDSI safety culture ties your implementation work together and sustains your IDDSI operations in the long run.

What do we mean by “IDDSI safety culture?” The concept of safety culture in the industrial safety business inspired us to develop this term. Organizations in high-hazard sectors — like construction, manufacturing, and warehousing — emphasize a safety mentality among employees.

“Safety culture isn’t about a transfer of information or giving facts to people. It’s about the values of an organization,” said Roche.

Executing safe behaviors isn't the primary focus of safety culture. Safety culture reflects an organization’s entire value system.

Here's what a hospital with IDDSI safety culture looks like:

• All employees — not just those involved with patient feeding — take ownership of helping maintain patient safety. Each person believes they play a part in sustaining IDDSI safety culture.

• IDDSI isn’t siloed to one department. Instead, staff integrates IDDSI into the larger patient safety program.

• Foodservice team members consistently test foods using the IDDSI testing methods and are dedicated to patient safety. They understand why they’re implementing IDDSI and its importance to the organization.

• Foodservice workers are committed to executing IDDSI well. They work both individually and as a team to help keep patients safe.

• Employees from other departments understand IDDSI, believe it's valuable, and support it across the organization.

• The institution emphasizes the IDDSI mindset through IDDSI posters and comprehensive training.

• Most importantly, employees recognize that IDDSI isn’t simply a new way to serve texture-modified foods. It’s a transformation of how they think about patient safety at mealtime.

To sum it up: in a hospital with IDDSI safety culture, IDDSI is integral to how the institution thinks and behaves.

Plus, when patient safety is core to a hospital’s DNA, employees are more likely to embrace it.

This culture-focused approach is more successful than assigning safety-oriented tasks to employees. Focusing on the IDDSI testing methods is ineffective without cultivating a staff-wide value of patient safety.

An under-the-radar truth about safety culture is that creating a new group culture is the best way to train employees on an unfamiliar concept. 

This strategy works better than a standard approach like relaying facts in a PowerPoint presentation. This dynamic is true with all types of education. But, it particularly happens with IDDSI training for two reasons:

• IDDSI is complicated.

• Improper implementation can cause potentially grievous consequences.

IDDSI posters foster IDDSI safety culture because they’re a visual reminder of your organization's values. Posters communicate that you highly value IDDSI since they’ve earned a spot on your kitchen's minimal wall space.

Ultimately, the purpose of IDDSI is to help increase our patients’ level of safety, so we created IDDSI posters that emphasize the message, “We test for safety.”

This message helps build IDDSI safety culture among foodservice workers. It also makes our posters different from any others. This concept is so important that we named our training program the Roche Dietitians "We Test For Safety” IDDSI Training Program.

Always keep in mind, though, your main goal isn’t administering training and putting up posters. Your objective is to cultivate a safety mindset through training and posters.

How do you put IDDSI safety culture into action? Here are the steps:

• Focus on developing an institution-wide commitment to IDDSI, rather than solely presenting your colleagues with IDDSI facts.

• Use an IDDSI training program that emphasizes a safety mindset among employees, instead of only teaching them how to adopt IDDSI.

• Put IDDSI posters on your kitchen walls as a visual reminder of your hospital’s values.

• When talking about IDDSI, mention it isn’t merely a new standard to follow. It’s an expansion of your hospital's safety mentality.

• Prioritize developing safety culture in your larger patient safety program through posters and education on other dimensions of safety.

One of the best parts of developing IDDSI safety culture is IDDSI no longer rests on your shoulders alone. When your colleagues are also committed to IDDSI, you’ll feel more supported across your institution.

READ MORE: Best Practices for IDDSI Language Usage: Insights from USIRG

Improving patient safety and serving your patients well with IDDSI

As dietitians and dietary managers, our goal is to serve others with the highest standard of nutritional care. By implementing IDDSI, you’re helping improve patient safety and serving your patients well. Ultimately, that’s what our work is about.

IDDSI is a significant investment of time, money, and staff energy. But, it’s worth it to help keep your patients safe and meet the standard of practice.

Use this checklist to guide your implementation efforts. And remember, you don’t have to do it alone.

Our resources exist to help you through the process. Are you ready to dive into IDDSI training? We’re here to support you. Learn more about the Complete IDDSI Training Bundle here:

DISCOVER THE COMPLETE TRAINING BUNDLE

We can customize the training to your organization’s learning management system. Call us for details at (708) 442-0123.