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Training Healthcare Teams for IDDSI Implementation

A female healthcare professional pours Thick-It® Original Food & Beverage Thickener in a bowl to thicken food for dysphagia patients

Guest Author: Margaret Roche, MS, RD, CSG, CDCES, FAND

The International Dysphagia Diet Standardisation Initiative (IDDSI)* provides a new, standardized way to define texture-modified diets and thickened liquids. It is now the global standard for serving foods and drinks to individuals with chewing and swallowing problems across all age groups and care settings.

IDDSI is exciting because it includes easy-to-use testing methods that can verify whether foods and drinks are prepared to the appropriate consistency. This will continue to have meaningful impacts on the safety and quality of texture-modified foods and thickened liquids served to those with dysphagia.

The IDDSI Framework is a visual representation of the various levels of IDDSI texture-modified foods and thickened drinks. Each level has three identifiers: name, number, and color. For example, Pureed is always represented by the name Pureed, the number 4, and the color green. Additionally, IDDSI outlines detailed descriptors for each food and drink level.

Many healthcare organizations are choosing to move forward with IDDSI implementation, especially since the Academy of Nutrition and Dietetics (AND) recently announced that beginning October 2021, it will no longer support the National Dysphagia Diet and will only include IDDSI in its Nutrition Care Manual. AND’s announcement stated that “it is imperative that all healthcare providers globally implement IDDSI, both to ensure patient safety and to maintain current standards of practice.”

IDDSI implementation requires a well-coordinated, interdisciplinary approach as well as robust team training. Because IDDSI presents a significant change in the way texture-modified diets and thickened liquids are identified, prepared, and tested, training must be more extensive than simply sharing information about each IDDSI level. Training that includes background information on why IDDSI changes are being made, how testing helps meet IDDSI standards, and the role every team member has in promoting patient safety will ensure a more successful IDDSI implementation.

Characteristics of a successful IDDSI training program include:

  1. A thorough, clear, and organized presentation of information:
    • Shared in an easy-to-understand curriculum.
    • Completely covers each IDDSI level.
    • Addresses which patients each IDDSI level is for and the types of chewing and swallowing problems those individuals have.
    • Defines the characteristics of foods and drinks for each IDDSI level.
    • Details the IDDSI testing methods for each level and explains how to perform them.
  2. The training focuses only on what the healthcare team needs to safely and effectively perform their jobs.
    • A quality IDDSI training program only includes the knowledge and skills team members will incorporate into their daily work.
  3. Multiple types of learners are considered.
    • It is important that all learners, including non-native English speakers and those who have lower literacy levels, are considered when designing an IDDSI training program.
    • Key topics should be reinforced throughout the program with many visual representations of IDDSI standards for each level.
    • There should be opportunities for hands-on experiences with IDDSI testing.
  4. It fosters independent problem solving.
    • After the IDDSI training program, each team member should be prepared to use the testing methods on their own to identify when foods and drinks do or do not meet IDDSI standards.
  5. The training promotes a culture of safety.
    • For IDDSI implementation to be successful, everyone on the team needs to understand why IDDSI is important and that they play a vital role in patient safety.


If you’d like to learn more about IDDSI, visit Roche Dietitians’ “Your Guide to IDDSI” as well as for the latest updates. You can also download our new guide “Understanding IDDSI.” For 11 nourishing, flavorful, and safe IDDSI Puree Level 4 meals, download “Variety Comes to the Table,” a dysphagia recipe book from the makers of the Thick-It® brand and a team of registered dietitians.

Margaret Roche, MS, RD, CSG, CDE, FAND is the founder of Roche Dietitians and a nationally recognized leader in nutrition for healthcare. A champion for senior nutrition, she advocates for quality improvement with texture-modified diets. Margaret has trained thousands on IDDSI implementation.

Margaret’s opinions and advice are her own. Roche Dietitians has previously been compensated by Kent Precision Foods Group, Inc., producers of the Thick-It® brand family of products, for their research and industry insights.

*Thick-It® brand is a gold sponsor of IDDSI. This article is NOT an official IDDSI resource, educational material, or education program, and it is NOT meant to replace materials and resources on

Always seek the advice of a physician or other qualified health provider with any questions you may have about the suitability of a particular diet or diet modification for individual patients or the use of Thick-It® products. The information contained herein is general and is not intended to be a substitute for professional medical advice, diagnosis, or treatment in any manner.

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