23/03/21

International Dysphagia Diet Standardisation

Initiative (IDDSI):
New Zealand Adoption

Anna Miles & Liz Beaglehole

IDDSI New Zealand Working Group Representatives

Anna Miles & Liz Beaglehole New Zealand

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Who are we?

• 4.9 million population
• 87% live in urban areas

• 40 public hospitals
• 35,000 residents in aged care
• 28 special schools

• 900 speech pathologists

• 1000 dietitians

• 2 specialist texture modified food

companies
• a handful of additional thickener
companies

Who are we?

• Range of food service providers in
NZ
• DHBs largely served by one or two
food service providers
• with few continuing with in-house
catering
• Aged care have a mixture of
external providers, in-house &
ready made texture modified meals
• Community-based SLTs/ DT
informing clients and family

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History of Standardization
Australasian Standards

Unmodified regular
0 Thin

1 Slightly Thick

Level 150
Mildly thick
2 Mildly Thick

Level 400 Moderately 3 Moderately

Thick
Thick

Level 900
Extremely Thick
4 Extremely
Thick

History of Standardization
Australasian Standards
Transitional Foods

7 Regular
Regular

7 Easy to chew
(Soft Mechanical)

6 Soft & Bite-sized

Texture A
Soft
5 Minced & Moist
Texture B
Minced and Moist
4 Pureed

Texture C
Smooth puree 5 Liquidised

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THE IMPLEMENTATION PLAN

Education,
Excite &
Enable
Dietitians &
SLTs

Educate,
Audit & Public
Mentorship Awareness
for Food
Producers
IDDSI Campaigns
Adoption
New
Zealand

Educate,
Audit & Government
Mentorship Policy
for Food Initiatives
Service

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SLPs and DTs

International Dysphagia Diet

Standardisation Initiative
(www.iddsi.org)
WE NEED YOUR HELP!

SOME CHALLENGESS

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Dietitians Role in Food Services

in NZ
• Small group of dietitians who work in food
service
• Aged care and long term care facilities
• Public & private hospitals
• Contracting companies – usually employ a
national dietitian
• Able to introduce the concept of IDDSI
nationally
• Dietitians prepare new menus
• But actual changes to preparation and practice
more difficult
• Lots of training and education sessions required

Soft & Bite Sized

• Similar sound in name to ‘soft’
• No sandwiches, bread or cut up
sausages in this group is a change in
practice for many
• Confusion also with ‘easy to chew’
• Hand cutting food to size is difficult
to implement in larger food service
operations
• Changes to many vegetables options
• Difficulty with suitable in-between
meal options that are suitable

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Puree Diets

• Puree main but soft sandwiches,

soft muffins or baked items
offered for between meals
• Overuse of puree diets in aged
care
• TMD and thickened fluids may be
started without assessment from
Speech Language Therapist
• Gravy – need extra? Should it be
thickened?

Implementation at Sites
• Educate all staff – clinical and
food service and care giver –
awareness of IDDSI
• Food service staff – on correct
preparation and testing methods
• Recommend reviewing all
residents on TMD to decide
actual diet required – SLT input
• Dietitians to plan options on the
cycle menu
• Audit and review meal options
and preparation
• On-going and long process!

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Thursday, 31st August 2017

Texture Modified Diet Use in

Residential Care Facilities in Auckland

Victoria Liang, Anna Miles, Julia Sekula, Paul Owen, Sharon

Broadmore, Andrea Braakhuis

Texture modified diets in aged care

facilities

16%
8%
6%
70%

Pureed Minced & moist

Soft & bite-sized Regular

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Evaluation of the implementation of the International Dysphagia Diet

Standardisation Initiative (IDDSI) and provision of Texture Modified
Diets in New Zealand age-care facilities: identifying the barriers and
enablers to facilitate implementation

Xiaojing Sharon Wu
PhD candidate, APD, RD
Andrea Braakhuis PhD
Anna Mlies PhD

Data collection

• Texture modified diet menu audit Foodservice and nutrition policies

Menu varieties

• Sample meals audit

IDDSI compliance & Meal presentation
• Mealtime observation

Staff performance & Environment

• Manager interviews
Perception of success, difficulty & confidence
Barriers and facilitators

• Staff self-administrated surveys

Knowledge level of IDDSI & TMDs
Staff attitudes towards IDDSI

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Staff attitude towards IDDSI framework

100%
94% staff want to learn more
80%
• Workshop
60%

40% • Training courses

20%
• Online resources
0%
Easy to put into practice Improve foodsafety • Seminars
Improve quality of care Enhance staff practice
Enhance team communication Hard to understand an comply • Hard copy handouts

Results – Implementation effectiveness

High
Low
Implementation difficulty
N=2

Easiest Hardest Moderate

N=2

Implementation success

Not successful Highly

successful

Confidence in staff performance & adoption

Not confident Highly confident

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Results – Significant barriers

• Poor material delivery and planning
– Complexity
– Evidence strength and quality

• Missing opinion leaders and strategies attract and involve staff during implementation
– Champions
– Incentives and rewards

• Lack of reflections and evaluations

– Team meetings
– Audits

• Lack of professional input

– Dietitian and SLTs

Results – Facilitators
• Established evidence and resources
– Perception of improving patient care
– Sufficient online resources

• Team leader
– Dedicated project manager
– Positive beliefs

• Network and communications

– Multi-disciplinary collaboration
– Organizational decision

• External support
– Commercial company

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SOME SUCCESSES

Food producers

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Food Service Providers

• Policy development
• Administration review & change to IDDSI
• Staff education
• Kitchen
• Feeders
• Newsletters for residents, families & staff
• Meal audits & re-coding (as needed)
• Recipe testing
• Tray audits

Media
• Radio NZ article
• NZ IDDSI newsletters
quarterly for 2 years
• HealthCert Bulletin 2018
and 2019
• Bidfood Newsletter (Food
distributor)
• Palliative Care NZ
newsletter
• Aged care newsletters
• NFOSD social media IDDSI
Challenge winners
Conferences
• Dietitian NZ
• NZSTA
• Aged Care Managers &
Nurses Education Study
• Nutrition for Positive Ageing
Conference
• Aged Residential Care Forum
• New Zealand Institute of
Food Science & Technology
Annual Conference

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Food Service Providers

Education
• E-learning chef
training in 2018 - all
head chefs in one
aged care company

• 2021 launch the

NZQA approved IDDSI
e-learning module
and micro-credential
in IDDSI for chefs
nationally

Thank you

Anna Miles
a.miles@auckland.ac.nz

Liz Beaglehole
liz@canterburydietitians.co.nz

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