International Dysphagia Diet Standardization Initiative implemented at Michigan Medicine

January 29, 2019  //  FOUND IN: News

Michigan Medicine recently implemented the International Dysphagia Diet Standardization Initiative (IDDSI).

The IDDSI is a global standard with terminology and definitions to describe texture-modified foods and thickened liquids used for individuals with dysphagia of all ages, in all care settings and for all cultures.

The IDDSI framework consists of a continuum of 8 levels (0-7). Levels are identified by text labels, numbers and color codes to improve safety and identification. The standardized descriptors and testing methods allow for consistent production and easy testing of thickened liquids and texture modified foods.

In January 2018, an IDDSI taskforce was convened consisting of representatives from Patient Food and Nutrition Services (PFANS), Speech Language Pathology and Pharmacy. The taskforce included ad hoc participants representing other groups and committees, including Michigan Medicine leadership.

Taskforce goals included: determining standardization for dysphagia diets between University Hospital and the Children’s and Women’s hospitals, facilitating communication among disciplines at Michigan Medicine, developing new dysphagia menus in collaboration with PFANS’s Food Service Systems Enhancement Committee, developing individual menus for each new dysphagia diet, determining new dysphagia diet food items and tray ticket names making them easily identifiable to staff, training PFANS staff to ensure dysphagia diet menu items being served to our patients have the appropriate texture/consistency, working with MiChart to update dysphagia diet selections in diet order sets, and communicating with key individuals to fan-out education of the IDDSI to providers, nurses, medical team members and staff members who interact with patients on a dysphagia diet.

In order to provide patients with good tasting, high-quality, safe dysphagia menu items, the PFANS executive chef and team created many dysphagia diet menu items. Prior to being included on the dysphagia diet menus, the menu items were taste-tested and approved by the PFANS compliance team after meeting dysphagia diet specific consistency, texture and particle size requirements.

The PFANS compliance team utilized several tests to evaluate the dysphagia menu items. For example, the Fork Drip Test was used to evaluate thick drinks and fluid foods by assessing how they flowed through the prongs of a fork and comparing their findings to the detailed descriptions of each dysphagia diet level.

All tests were conducted to ensure patients would be served dysphagia diet menu items that tasted good and could be consumed without risk of aspiration or choking. The taskforce thanks all those involved in working to successfully implement the IDDSI at Michigan Medicine.

For further questions, please contact Kit Werner, Ph.D., M.S., R.D.N., director of PFANS at More information about IDDSI is available at