Development of International Terminology and Definitions for Texture-Modified Foods and Thickened Fluids Used in Dysphagia Management: The IDDSI Framework.

Dysphagia is estimated to affect ~8% of the world's population (~590 million people). Texture-modified foods and thickened drinks are commonly used to reduce the risks of choking and aspiration. The International Dysphagia Diet Standardisation Initiative (IDDSI) was founded with the goal of developing globally standardized terminology and definitions for texture-modified foods and liquids applicable to individuals with dysphagia of all ages, in all care settings, and all cultures. A multi-professional volunteer committee developed a dysphagia diet framework through systematic review and stakeholder consultation. First, a survey of existing national terminologies and current practice was conducted, receiving 2050 responses from 33 countries. Respondents included individuals with dysphagia; their caregivers; organizations supporting individuals with dysphagia; healthcare professionals; food service providers; researchers; and industry. The results revealed common use of 3-4 levels of food texture (54 different names) and ≥3 levels of liquid thickness (27 different names). Substantial support was expressed for international standardization. Next, a systematic review regarding the impact of food texture and liquid consistency on swallowing was completed. A meeting was then convened to review data from previous phases, and develop a draft framework. A further international stakeholder survey sought feedback to guide framework refinement; 3190 responses were received from 57 countries. The IDDSI Framework (released in November, 2015) involves a continuum of 8 levels (0-7) identified by numbers, text labels, color codes, definitions, and measurement methods. The IDDSI Framework is recommended for implementation throughout the world.

The influence of food texture and liquid consistency modification on swallowing physiology and function: a systematic review.

Texture modification has become one of the most common forms of intervention for dysphagia, and is widely considered important for promoting safe and efficient swallowing. However, to date, there is no single convention with respect to the terminology used to describe levels of liquid thickening or food texture modification for clinical use. As a first step toward building a common taxonomy, a systematic review was undertaken to identify empirical evidence describing the impact of liquid consistency and food texture on swallowing behavior. A multi-engine search yielded 10,147 non-duplicate articles, which were screened for relevance. A team of ten international researchers collaborated to conduct full-text reviews for 488 of these articles, which met the study inclusion criteria. Of these, 36 articles were found to contain specific information comparing oral processing or swallowing behaviors for at least two liquid consistencies or food textures. Qualitative synthesis revealed two key trends with respect to the impact of thickening liquids on swallowing: thicker liquids reduce the risk of penetration-aspiration, but also increase the risk of post-swallow residue in the pharynx. The literature was insufficient to support the delineation of specific viscosity boundaries or other quantifiable material properties related to these clinical outcomes. With respect to food texture, the literature pointed to properties of hardness, cohesiveness, and slipperiness as being relevant both for physiological behaviors and bolus flow patterns. The literature suggests a need to classify food and fluid behavior in the context of the physiological processes involved in oral transport and flow initiation.

Erratum to: The Influence of Food Texture and Liquid Consistency Modification on Swallowing Physiology and Function: A Systematic Review.

Erratum to: Dysphagia DOI 10.1007/s00455-014-9578-x. In the original version of this article, Fig. 1 was published incorrectly. The corrected figure is given below.

Care staff perceptions of choking incidents: what details are reported?

BACKGROUND: Following a series of fatal choking incidents in one UK specialist service, this study evaluated the detail included in incident reporting. This study compared the enhanced reporting system in the specialist service with the national reporting and learning system. METHODS: Eligible reports were selected from a national organization and a specialist service using search terms relevant to adults with intellectual disability and/or mental ill health. Qualitative analysis was completed with comparison of themes identified in both sets of reports. FINDINGS: The numbers of choking incidents identified in national reports suggest underreporting compared with the specialist service and varying levels of severity. Themes included trends in timing, care setting and food textures as perceived by staff. CONCLUSIONS: This study demonstrates paucity of detail in reporting in systems without additional question prompts. Adding these questions requires staff to include greater detail which enables learning and risk mitigation to take place.

Hydration--the missing part of nutritional care.

Dehydration contributes to poor patient outcomes and can lead to avoidable harm. This article analyses incident reports from National Reporting and Learning System (NRLS) relating to hydration and shows that this area of care continues to be frequently neglected. Reasons for this are suggested with recommendations for changing practice to reduce the negative impact this has on patient outcomes.

The importance of applying human factors to nursing practice.

The aim of this series is to introduce the topic of human factors and to show how it can be used in nursing practice on the ward and in nursing management, to improve the safety of patient care. Human factors can be used to make many aspects of working life easier, and if it is easier to do it is less likely to go wrong. This article discusses the importance of human factors in nursing and provides some practical suggestions on how to apply the principles of human factors. Forthcoming articles will examine human factors tools, surgical safety and human reliability in more detail.

Nutrition and patient safety a report from the National Patient Safety Agency (United Kingdom).

The National Patient Safety Agency (NPSA), established in 2001 as part of the U.K. National Health Service (NHS), extended it's portfolio of patient safety programmes to include nutrition in 2006. Since 2006 the focus of the NPSA's nutrition programme has been to raise awareness of nutrition as a patient safety issue and to encourage healthcare staff to report nutrition related patient safety incidents to the NPSA's reporting data base, the Reporting and Learning System, to identify key themes and areas for national learning. In the summer of 2009 the NPSA were invited by the International Hospital Federation to join the Improving Infant and Child Food Safety in Health Facilities project as a member of the Advisory Group. This opportunity allowed for the NPSA to share their experience and knowledge of nutrition patient safety themes.

Time to share. Interview by Adele Waters.

The RCN's Nutrition now campaign, supported by Nursing Standard, is giving nurses the resources to stop patients becoming dehydrated and malnourished.

Improving the nutritional care of patients in hospital.

The provision of good nutrition has long been recognised as essential for hospital patients and ensuring patients received adequate food used to be a key nursing responsibility. However, changes in the preparation and delivery of hospital food and in the nurse's role. have reduced nurses' control over their patients' diet. This article reports on the progress of the Better Hospital Food programme, which was implemented to improve food services and give back more control over food to nurses.

The Need for International Terminology and Definitions for Texture-Modified Foods and Thickened Liquids Used in Dysphagia Management: Foundations of a Global Initiative.

Conservative estimates suggest that dysphagia (difficulty swallowing) affects approximately 8 % of the world's population. Dysphagia is associated with malnutrition, dehydration, chest infection and potentially death. While promising treatments are being developed to improve function, the modification of food texture and liquid thickness has become a cornerstone of dysphagia management. Foods are chopped, mashed or puréed to compensate for chewing difficulties or fatigue, improve swallowing safety and avoid asphyxiation. Liquids are typically thickened to slow their speed of transit through the oral and pharyngeal phases of swallowing, to avoid aspiration of material into the airway and improve transit to the esophagus. Food texture and liquid modification for dysphagia management occurs throughout the world. However, the names, the number of levels of modification and characteristics vary within and across countries. Multiple labels increase the risk to patient safety. National standardization of terminology and definitions has been promoted as a means to improve patient safety and inter-professional communication. This article documents the need for international standardized terminology and definitions for texture-modified foods and liquids for individuals with dysphagia. Furthermore, it documents the research plan and foundations of a global initiative dedicated to this purpose.