Diet Compendium Update: Diet Texture and Consistency Changes Jean Helps, RD Regional Clinical Nutrition Manager Long Term Care

WRHA Feeding and Swallowing Expert Review Group RD and SLP representation Site representation: Concordia Place Deer Lodge Centre Golden Links Lodge Grace General Hospital River Park Gardens Victoria Hospital WRHA Home Care

Feeding and Swallowing Executive Summary Goal: Review the literature and evaluate practice to determine the continuum of texture and consistency modified diets. Conclusion: IDDSI recommendations are current best practice

Copyright November 2017 - Used with permission from IDDSI International Dysphagia Diet Standardisation Initiative - Industry Update July 2016 Copyright November 2017 - Used with permission from IDDSI www.IDDSI.org copyright 2016

Copyright November 2017 - Used with permission from IDDSI International Dysphagia Diet Standardisation Initiative - Industry Update July 2016 Copyright November 2017 - Used with permission from IDDSI www.IDDSI.org copyright 2016

Copyright November 2017 - Used with permission from IDDSI International Dysphagia Diet Standardisation Initiative - Industry Update July 2016 Copyright November 2017 - Used with permission from IDDSI www.IDDSI.org copyright 2016

Copyright November 2017 - Used with permission from IDDSI International Dysphagia Diet Standardisation Initiative - Industry Update July 2016 Copyright November 2017 - Used with permission from IDDSI www.IDDSI.org copyright 2016

Middle of the (current) Continuum International Dysphagia Diet Standardisation Initiative - Industry Update July 2016 Middle of the (current) Continuum Soft Soft-minced Minced Total minced www.IDDSI.org copyright 2016

Copyright November 2017 - Used with permission from IDDSI International Dysphagia Diet Standardisation Initiative - Industry Update July 2016 These standardized changes are needed for patient safety, clinical efficiency, ease of use of commercially prepared products, and development of clinical evidence. Copyright November 2017 - Used with permission from IDDSI www.IDDSI.org copyright 2016

Copyright November 2017 - Used with permission from IDDSI International Dysphagia Diet Standardisation Initiative - Industry Update July 2016 Copyright November 2017 - Used with permission from IDDSI www.IDDSI.org copyright 2016

Copyright November 2017 - Used with permission from IDDSI International Dysphagia Diet Standardisation Initiative - Industry Update July 2016 Copyright November 2017 - Used with permission from IDDSI www.IDDSI.org copyright 2016

IDDSI Framework The framework consists of food and fluid consistencies Levels are identified by text labels, numbers, and colour codes to improve safety and identification Note “Regular (7)” has a subcategory: “Easy to Chew” not all aspects of the framework need to be adopted to be IDDSI compliant.

Phase 1 Changes Coming May 2019 Copyright November 2017 - Used with permission from IDDSI Phase 1 Changes Coming May 2019 FUTURE USE X X X

Changes from Manufacturers Manufacturers of modified foods and fluids are moving towards meeting IDDSI guidelines starting in January 2019 You will start seeing dual labelled thickened liquids in 2019 Once you finish using your site product and suppliers have depleted their old labelled product Within WRHA – changes to take place after April 2019

Commercial Products Nestle ThickenUp and Nestle ThickenUp Clear In the process of transitioning to IDDSI labels Lynch Thickening Powder No designation on the label currently re: diet terminology Sysco Thickened Juice and Water Not yet transitioned to IDDSI labeling Hormel Thickened Milk Transition complete for Nectar Thick Not yet transitioned for Honey Thick Oasis Hydra ?

ThickenUp & ThickenUp Clear 30 sites noted they use Nestle products, 2 sites noted Lynch and Sysco Haven’t heard from all sites Blue highlighted occurred a few weeks ago, sites should be seeing these products soon Yellow highlighted occurred more recently, supplier to provide a better sense of the time frame for transition soon

Prevalence of Texture Modifications Dysphagia prevalence in LTC has been estimated to be over 66% (Dietitians of Canada) Within WRHA approximately 50% of PCH residents are on texture modified diets 7% of residents are on thickened liquid diets

What is involved to ADOPT? Implementing IDDSI will take time and will involve changes to: Kitchen related: Food and liquid definitions Production process and recipes Production lists (tallies), diet compliances in recipes Food and liquid terminology Menus, diet manual, lists, orientation material Point of service considerations, including testing Site wide related: Education to staff in several departments Updating diet information and forms Updated policies and procedures

Support for Implementation Visuals: What and Why of IDDSI Transition Table comparing current and new diet terminology Industry resources IDDSI Resources Diet definitions and descriptions Food Audit forms and process Education Session held January 22 and 23

Copyright November 2017 - Used with permission from IDDSI FUTURE USE X = No Fluids X = Pediatric Only X = Regular

Industry Resources Blue rather than yellow spoon

Dual Labelling Lyons Magnus/Sysco Juice

Hormel Milk Old label New label

IDDSI Resources Diet Descriptions Audit forms and process

Copyright November 2017 - Used with permission from IDDSI

Copyright November 2017 - Used with permission from IDDSI

Education Sessions – January 22 and 23 Representation from 38 of 39 sites Food Service representation from all sites except 9 Clinical Dietitian representation from all sites except 3 Some sites had 3 representatives from a variety of roles All LTC SLP attended Two nursing leaders attended Total of 70 attendees

Education Sessions – Feedback Question: Yes No Better Awareness 46 Concerns 25 18

Education Sessions – Comments Concerns: Transition is difficult for staff Training staff – time and resources and staff comprehension Buy in/acceptance of the change What will help?: Resources – posters Standardized recipes Seeing the chart made it easier and the flow test is pretty straightforward Locally produced video

Education Sessions – General Comments Great session, Very informative session Information was very clear Excellent hands on session Ability to access a contact easily should any concerns arise, but very informative Thank you for the opportunity, great session, I wish my FSS and lead cook attended Slow roll out (e.g. fluid first) will allow for a greater success in transitioning Support for providing education – not just the RD Food Texture update will be more of a challenge

Recommendation for Future Focus… Implementation of food textures in 2020 Review Food Textures and compare this to our current diets Current Terminology New Terminology Standard Standard/Regular (7) Soft/Soft Minced Easy to Chew (subcategory 7) Minced To be determined Total Minced Minced and Moist (5) Pureed Pureed (4) Blenderized Liquidised (3)

Our plan moving forward… Identify a transition date Finalize package for transition Finalize education materials Initial goal: transition fluids within the first quarter of 2019/2020 Future plan: transition foods in 2020 (?fall 2020)