IDDSI Q&A: Can we change between IDDSI levels for An individual?

Roche Dietitians is doing a series of Q&A about IDDSI from our clients, partners, and IDDSI Community Group on LinkedIn. We welcome your questions about IDDSI. To submit a question, type your question in the comment section below. To view the other Q&As, visit our blog.

Question:

“Is IDDSI adaptable to an individual’s needs or do the levels need to be followed correctly every time?

I have seen care staff adjust the consistency of drinks according to an individual’s swallow capabilities. For example, if someone was prescribed Pureed (Level 4), care staff have given a consistency that is between Moderately Thick (Level 3) and Pureed (Level 4). 

It’s a case of the resident not drinking any fluids because they are too thick on Pureed (Level 4), even though the Speech & Language team has advised and written into a swallow care plan that the resident is a Pureed (Level 4).

For a safety issue, I would be inclined to say that Pureed (Level 4) must be followed. But from a nutrition and hydration point of view, I am torn.”

Answer:

Here in the United States, we are strict about following doctor’s orders for foods and liquids. Our skilled nursing home surveyors from the state and federal governments check that we are serving diets as prescribed.

If a resident has an order for Moderately Thick (Level 3), we are required to serve only that level. Of course, some don’t always do it right every time, but the standard is to follow orders. If an individual’s needs change, we need to contact the doctor to get a new order.

Dietitians and dining managers audit their doctors’ orders on a regular basis. They make sure foods and drinks are served according to the order and how it is planned on the menu.