Diet Compendium Update Diet Texture and Consistency Changes

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

Copyright November 2017 - Used with permission from IDDSI

Copyright November 2017 - Used with permission from IDDSI

Copyright November 2017 - Used with permission from IDDSI

Middle of the (current) Continuum • Soft-minced • Minced • Total minced

Copyright November 2017 - Used with permission from IDDSI

Copyright November 2017 - Used with permission from IDDSI

Copyright November 2017 - Used with permission from IDDSI

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”

Copyright November 2017 - Used with permission from IDDSI FUTURE USE X X X Pha Cha se 1 nge Com s Ma ing y 20 19

Changes from 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 Thicken. Up and Nestle Thicken. Up 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 – ?

Thicken. Up & Thicken. Up Clear

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 X X = No Fluids = Pediatric Only = Regular

Industry Resources

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 0 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/Regular (7) Soft/Soft Minced Easy to Chew (subcategory 7) Minced To be determined Total Minced and Moist (5) 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)