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IDDSI Survey - Soft [but not necessarily bite-sized]

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Tuesday, 10 July 2018

IDDSI Survey - Soft [but not necessarily bite-sized]

Survey available regarding people who require a soft diet but don't need it to be cut into small pieces before serving.

Take the survey here: https://www.surveymonkey.com/r/KYW2VFN

Info from the IDDSI survey:

"IDDSI has received a number of questions suggesting that people are looking for a label and testing methods for foods that are ‘soft’ but not necessarily served in ‘bite-sized’ pieces (e.g. without particle size restriction).  Specifically, “how do we order ‘soft’ whole foods (e.g. omelette, fish), while avoiding things like nuts, tough meats, stringy/fibrous foods, etc?”

In order to talk about this question, the IDDSI Board debated and used the following rules:

  • The IDDSI Framework is intended to be used for people with dysphagia, where there is a risk of aspiration or choking
  • The IDDSI Framework is NOT intended for people without dysphagia or recognized choking risk.
  • The IDDSI framework is the same as previous or existing national dysphagia diets that define the size of the food served for ‘soft’ food, to reduce choking risk.
  • To work out whether a person has a choking risk and requires “Level 6 Soft and Bite-Sized food” requires clinical assessment, decision-making and documentation.
  • There are some situations where people who do not have dysphagia or an increased choking risk might still benefit from ‘soft’ whole food. When there is no increased risk of choking, identifying the size of individual food pieces is not needed. Just as it is possible to order a therapeutic diet that involves specifications like “diabetic” or “renal”, we appreciate it is important to be able to order regular foods that are soft, without needing them be cut into ‘bite-sized’ pieces when served.

In most hospitals ‘soft’ foods can be ordered from a regular diet menu rather than a ‘dysphagia diet menu’. In non-hospital settings such as residential care facilities (for the elderly or individuals with developmental disability) or group homes, there is often only one menu to choose from.  With the benefits that come from standardization, people are now searching for an agreed upon term that covers regular foods that are soft but not necessarily served in ‘bite-sized’ pieces.

We are asking for your help to work out (a) whether you think this subcategory of food (with a corresponding label and testing guidelines) is needed in your facility, workplace or home and (b) what IDDSI-compatible term could be used that doesn't cause confusion with the existing IDDSI terminology. 

Note, the creation of a subcategory of soft food that is not ‘bite-sized’ would NOT be a new IDDSI level, but rather providing further details for different types of Level 7 Regular foods.  Level 7 Regular is the only IDDSI Level that does not have restrictions on the size of food pieces.  Level 7 also includes the full range of regular food textures. The proposal would expand Level 7 to define a Restricted subcategory of whole soft foods (without a restriction of the size of food pieces). This would allow us to preserve the definition of Unrestricted Level 7 Regular foods; that includes all food textures that are developmentally and age appropriate in people who do not have dysphagia or increased choking risk."

Helen Keen
Helen Keen says:
Jul 16, 2018 10:30 AM

It seems essential we have another level/descriptor to replace 'fork-mashable' given the recent patient safety alert regarding using the term 'soft' to describe diets. I quite like the term soft chew or easy chew, with clarification to avoid all HRFs.