IDDSI Framework
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- Drinking a glass of water in the morning before your coffee or tea.
- Keeping a water bottle or glass of water on your desk at work.
- If you don’t love the taste of tap water, you could look into buying a water filter (such as Brita), these can be inexpensive and purchased at Wal-Mart.
- If you find the flavor of water boring, you can infuse your water with fruits, vegetables and herbs to your drink. Check out the quick and easy recipes below.
- Strawberry + Mint
- Blackberry + Mint
- Lemon + Lime + Mint
- Watermelon + Basil
- Orange + Blueberry
- Grapefruit + Oranges + Lemons +Limes
- Watermelon + Kiwi + Strawberries
- Raspberries + Lemon
- Blueberries + Lemon + Cucumber
- Foodservice directors must know the patients’ needs and expectations.
- Adequate time must be allotted for preparation before implementation.
- A business plan should be created and presented to stakeholders.
- Approval must be granted for changes to budget/purchasing new equipment.
- Staff must be appropriately trained before going live with the Spoken Menu.
- Alternative arrangements must be made for patients who are not appropriate for the Spoken Menu (i.e. for patients who cannot communicate their meal choices).
- Schedules need to be made for staff, and the layout of the hospital should be kept in mind to increase efficiency when taking patients’ orders.
- Scripts should be created for staff to use when speaking with patients.
Nutrition Supplementation
June 24th, 2021What is Nutritional Supplementation?
Tablets, powders, capsules, drinks, and energy bars; nutrition supplements come in a variety of forms. These days, nutrition supplements are readily available, and can be found almost everywhere we shop, including pharmacies, grocery stores and health food stores. Furthermore, we are surrounded by advertisements which encourage us to take a wide variety of supplements to stay healthy. According to Statistics Canada, in 2015 over 45% of Canadian’s reported consuming at least one nutrition supplement daily. However, the question remains: do we really need to take a nutrition supplement to maintain our health?
Benefits of the Nutritional Supplementation:
Our bodies require a variety of nutrients, as each nutrient plays an important role in optimizing our health. The great thing about getting our nutrient needs through food is that many heathy foods, for example fish and vegetables are high in a wide variety of vitamins and minerals! It is important to include an assortment of foods in our diet to ensure that we are meeting our needs. For most vitamins, it is possible and achievable to meet 100% of our needs orally (with the exception being folate for women and vitamin D for those over 50).
Certain groups such as athletes, women who are pregnant or lactating, those who are vegetarian or vegan, and individuals who are anemic or severely deficient in a specific nutrient may require additional vitamin and mineral supplementation.
If you are eating a balanced diet, you likely do not require a multivitamin supplement. Some multivitamins, especially ones that require you to take more than one tablet per day, may cause you to consume too much of some nutrients. Some vitamins and minerals, such as vitamin A, can have dangerous consequences if consumed in excess. A multivitamin cannot take the place of eating a variety of healthy foods. Foods provide more than just vitamins and minerals; they contain other healthy elements such as fibre which have added health benefits. However, for people who don’t get enough vitamins and minerals from food alone, have a poor appetite, or avoid certain food groups, a multivitamin may be beneficial.
If you have concerns that you may not be meeting your individual requirements, speak to your medical doctor and pharmacist before beginning any nutritional supplements, as they may interact with other medications you are taking and can be dangerous in high amounts.
Challenges Associated with the Spoken Menu:
Check out the chart below which displays the dietary requirements and food sources of 8 common nutrients.
| Nutrient | Requirements | Common Sources |
| Vitamin B12 | Adults over 18 years of age require 2.4 mcg/d *Health Canada recommends adults over 50 consume foods fortified with vitamin B12 or take a supplement | Beef liver Clams Fish Poultry Eggs Milk Foods fortified with Vitamin B12 such as breakfast cereals |
| Calcium | Men and women age 19 – 5 require 1000 mg/dMen age 51 – 70 require 1000 mg/dWomen age 51 – 70 require 1200 mg/d | Milk Yogurt Cheese Kale Broccoli Chinese cabbage Salmon and canned sardines with bones Calcium fortified foods such as breakfast cereal, soy and rice beverages, tofu. |
| Vitamin C | Adult men require 90 mg/dAdult women require 75 mg/d If you smoke, you require an additional 35 mg of vitamin C, in addition to your daily recommended needs. | Citrus fruits Bell peppers Kiwi Broccoli Strawberries Cantaloupe Potatoes Tomatoes |
| Vitamin D | Men and women 19 – 70 years old need 600 IU/d or 15 mcg/dMen and women 71 years and older need 800 IU/d or 20 mcg/d *Health Canada recommends that everyone over the age of 50 take a Vitamin D supplement of 400 IU each day. | Flesh of fatty fish (salmon, tuna, mackerel) Cheese Egg yolks Vitamin D fortified items such as milk, breakfast cereals, orange juice, yogurt, margarine, soy beverages. *We also we get vitamin D from the sun, however it is best to limit sun exposure to decrease the risk of skin cancer. |
| Folate | Adults over 19 years old require 400 mcg/d *Health Canada recommends that females who are of child bearing age consume a 400 mcg supplement of folic acid daily. | Asparagus Brussel sprouts Nuts Beans Oranges Peas Dark green leafy vegetables Items fortified with folate such as bread, cereal, bagels, rice and pasta |
| Iron | Men ages 19 – 51 require 8 mg/dWomen ages 19 -51 require 18 m/dMen and women over 51 years of age require 8 mg/d | Oysters Chicken Beef Seafood Eggs Tofu Potatoes Chocolate Nuts Beans Fortified grain products such as breakfast cereals, flour, bread, rice |
| Omega 3s | Adult men need 1.6 grams of ALA (alpha-linolenic acid) per dayAdult women need 1.1 grams of ALA per day | Flaxseed oil Canola oil Walnut oil Nuts Seeds Fish |
| Zinc | Men over 19 years of age require 11 mg/dWomen over 19 years of age require 8 mg/d | Oysters Poultry Beef Nuts Beans Whole Grains Crab Lobster Foods fortified with zinc such as breakfast cereals and dairy products |
B – Fit: Rethink Your Drink
June 10th, 2021Coffee, frappuccino’s, juice, Gatorade, vitamin water, the list goes on and on. With all the drink choices that are at our finger tips, it can be difficult to determine what is healthy.
While I’m sure you’ve heard that water is the best beverage choice, deciphering why other beverages don’t quite compare is much more difficult. If you’re like me, you won’t be caught without your a.m. cup of coffee. How many times has someone tried to damper your morning coffee routine by telling you “coffee dehydrates you”? You can counter that negativity by mentioning to your colleague that research has suggested that coffee in moderate amounts (i.e. 3-4 cups per day) in individuals who regularly drink coffee does not have a dehydrating effect. This means that you are not excreting more fluids than you are taking in. However, if you stop drinking coffee for as little as 4 days, when you resume drinking coffee it may have more of a diuretic effect that day (just in case you needed another reason to justify drinking coffee daily). While this research may be a slight win for coffee lovers, coffee is not without its faults. As you may know black coffee is calorie free, which is great for the waistline. The issue lies with what is added into the coffee such as cream and sugar. A medium double double from Tim Hortons has over 200 calories and 22 grams of sugar (that’s over 5 tsp)!
Challenge: Try slowly decreasing the sugar or cream in your coffee to make it a healthier choice. Going from a double double coffee to black coffee overnight will likely will be too drastic of a change. However, if you could gradually change the cream to milk (or even 1 cream 1 milk) and ask for 1 ½ sugars instead of 2 you can end up making meaningful changes. Continue decreasing the cream and sugar content overtime so your taste buds can get use to the new (less sweet) taste
Since we discussed the nutrition content of coffee, it only seems fit to talk about specialty caffeine beverages (Starbucks, I’m looking at you). Starbucks has created a huge variety of caffeinated beverages that don’t resemble your plain old coffee what so ever. A grande vanilla latte has 250 calories and 35 grams of sugar (almost 9 tsp). The grande Mocha Frappuccino has 400 calories and 61 grams of sugar (15 tsp)! These are just a few of the many caffeinated beverages that are available, and if we’re not careful the calories add up fast. The problem with drinking our calories is that we often do not decrease the calories we are consuming from food as a result. For example, if you were to drink a mocha frappuccino, you likely will still have the same breakfast or snack item on top of the drink, this is resulting in 400 extra calories every day. These drinks are okay every once and a while as a treat, however if you are consuming them daily the additional calories can add up fast.
Moving on to another popular morning beverage, juice. To make an 8oz glass of orange juice, 4 – 5 medium oranges are required. Imagine eating 5 oranges in one sitting, would you feel as full as you do after drinking 1 glass of orange juice? Likely not. That’s because juice lacks fiber, which is a non-digestible carbohydrate that helps keep you full. Whenever possible, aim to eat the whole fruit as opposed to the juiced version of it.
According to CBC’s Marketplace, Canadians spend more than $450 million a year on sports drinks. However, did you know that you likely don’t need to drink Gatorade during or after a workout? Gatorade contains additional nutrients and carbohydrates (glucose a type of sugar) that may be beneficial for athletes who engage in strenuous exercise for a long period of time (over 90 minutes). It is also beneficial for those who exercise in very hot weather conditions. For the average gym-goer, the caloric content of sports drinks can lead to weight gain. Considering that many people exercise to lose weight, the additional calories from these drinks may not be beneficial. Overall, your need for a sports drink to refuel after a workout depends on many factors, however most non-elite athletes can rehydrate just fine with water.
Vitamin water in a lot of ways is similar to sports drinks. It contains added micronutrients such as vitamins B and C. The good news is that most of the population is not deficient in these vitamins (so we don’t need extra in our drinks). Vitamins B and C are also water-soluble vitamins, this means when we consume them in excess we lose what we don’t need through urination. This takes the saying “flushing money down the toilet” to a whole new level. Ultimately, if you have concerns that you may be deficient in certain micronutrients, speaking with your doctor is always the safest bet. Some flavours of vitamin water can contain up to 32 grams of added sugar per bottle. They are marketed as a healthy beverage alternative to soda, however in reality they are not much better. Adding vitamins that we don’t typically need to a sugary drink does not make it healthy.
When rethinking your drink, water is going to be an obvious topic of discussion. It is best to drink water most often. Water is a calorie free way to stay hydrated. It can help to improve physical performance, relieve constipation and decrease fatigue. Individual fluid requirements vary greatly. We lose water daily through breathing, sweating, urine and bowel movements. However, if you exercise or live in a hot climate, you will require additional water to stay hydrated. An easy way to tell if you are drinking enough water is to look at your urine. If it is a clear or pale yellow colour, you are likely drinking enough fluids. If it is a concentrated yellow colour you need to increase how much water you are drinking daily. It can be easy to increase the amount of water that you are drinking.
You can try:
Infused Water Recipes
Infusing water is an easy way to increase the flavor of your drink without adding lots of calories or sugar. When infusing water, you want to add your ingredients and let the water sit in the fridge for at least 2 hours prior to serving, however, it’s best if you let it sit overnight. Top off the pitcher with ice cubes and pour yourself a glass or two, it’s that easy. If you are adding herbs to your water its best to tear the leaves to release the oils.
The combinations of fruits, vegetables and herbs that can be used is endless. Below are just a few flavor combinations you can try.
IDDSI Framework
May 10th, 2021Over 590 million people worldwide live with a swallowing disorder called dysphagia2. Dysphagia occurs when an individual experiences difficulty or discomfort when swallowing2. One of the key management techniques for people with dysphagia are therapeutic diets that include texture-modified foods and thickened liquids2. In North America, the varying textures are most commonly referred to as “soft”, “minced”, “pureed”, or “liquidized”, and the beverages “nectar”, “honey”, or “pudding thick”. However, these terms may vary between institutions and are not standardized internationally. This means that the same texture-modified food or thickened beverage can differ in texture or consistency from facility to facility2.
An American task force identified 40 different names used to label solid food and 18 different names to describe thickened beverages1. This can be compared to an Australian study which found 95 different labels used to describe texture-modified food and 12 different names to describe thickened beverages1. This lack of standardization poses potential safety concerns for patients with dysphagia. It also creates confusion for healthcare professionals, researchers, patients, and caregivers.
Research studies utilize different terminology and definitions to describe the dysphagia diet, this makes it difficult to compare study outcomes. If more researchers used the same descriptors for thickened beverages and texture modified food, the ability to compare results would be improved. This would allow for researchers to better determine the therapeutic benefits of the dysphagia diet.
The International Dysphagia Diet Standardization Initiative (IDDSI) began in 2013 to help address the lack of standardized terminology and definitions for dysphagia diets2. This initiative resulted in the IDDSI Framework.
As this is an international initiative, this framework does not include terms such as “nectar”, “honey”, and “pudding thick”, which are commonly used in North America but, not understood worldwide2. The IDDSI selected terms which are understood across all countries and the framework is available in numerous languages. The IDDSI has developed a systematic method for testing texture-modified food and thickened beverage compliance. The texture of food items can be determined using the fork method and the syringe method can be used to evaluate the thickness of liquids. Click on the links below for more detailed information on each of these methods.
http://iddsi.org/framework/drink-testing-methods/
http://iddsi.org/framework/food-testing-methods/
The adoption of the IDDSI Framework is voluntary. However, the IDDSI has selected January 1st, 2019 as their goal date when all Canadian and American texture-modified food and thickened beverage products will use the IDDSI terminology. Many acute care facilities and industry organizations around the world have already implemented the IDDSI Framework. A pilot study conducted in Germany revealed many strategies that can assist with successful implementation of the IDDSI terminology and definitions3. The study suggested that the standardized terminology framework helps to reduce the risk of death by accidental chocking by addressing errors of incorrectly supplied meals3. This offers the organization a benefit in reduced liability3.
It is important to recognize that the adoption of the IDDSI Framework is not without its challenges. For food and drink producers, there is a cost associated with reformatting texture-modified food and thickened beverage products to meet the standards. Research and development is required to change recipes; this can be a lengthy and expensive process. Suppliers must also repackage their products to reflect the new terminology. For example, many North American companies use the terms “nectar”, “honey”, and “pudding thick” to describe their thickened beverages. These product labels would need to be changed to reflect the new IDDSI terminology.
For healthcare institutions that prepare texture-modified foods and thickened beverages in-house, recipes will need to be tested to determine compliance with the IDDSI standards. The additional labor required to test and reformulate recipes could be costly to organizations. Additional time is also required to train staff on the IDDSI Framework, and organizations must overcome staff’s reluctance to change.
It may not be feasible for larger hospitals to make their thickened beverages in-house due to the volume required. For example, many hospitals and long-term care homes outsource their thickened drinks from other companies. These institutions will only be in compliance with the IDDSI standards if the companies who they purchase from follow the framework. Therefore, it is important that food and beverage companies continue the movement towards adopting the IDDSI Framework.
Some food and drink suppliers have already begun using the IDDSI terminology. It has been suggested by the IDDSI board of directors that companies may use dual language during the transition stages. The company’s traditional labeling (such as nectar thick), as well as the IDDSI labeling, would be on the package. This dual-language may make it easier for hospitals to train their staff in the new terminology. Some suppliers are aiming to utilize these transition labels as early as April 2018.
Overall, the standardized terminology and definitions that have been created by IDDSI provide improved patient safety and allow for higher quality research to be conducted. Many organizations are moving towards adopting the IDDSI Framework, however, these changes require time, extensive planning, and budgetary considerations. For the seamless implementation of the IDDSI Framework, it must be adopted by both acute and long-term care facilities, as well as producers of texture-modified foods and thickened beverages.
The Spoken Menu
April 16th, 2021With the current push to improve patient satisfaction in acute care settings, many hospitals are looking to make changes to their patient foodservices. These changes are extending beyond the food itself. Research has suggested that a patient’s satisfaction with hospital meals not only depends on food quality, but also on the way it is presented and delivered2. The Spoken Menu is a foodservice model that is increasingly being implemented as a means of improving patient satisfaction. This concept mimics a restaurant-style foodservice system as staff (sometimes titled patient care host/hostess or attendant) visit patients at the bedside, discuss the menu options with them, and take their order. The staff member can assist patients with their meal selection based on their dietary restrictions8. Patients usually choose their meal one to two hours in advance of it being delivered, however it can be up to 24 hours in advance, depending on the facility.
Benefits of the Spoken Menu:
Acute care settings that have implemented the Spoken Menu model have seen many benefits associated with it. Studies have shown that patient food consumption is higher with the Spoken Menu model when compared to the printed menu model. As patients eat more with the Spoken Menu, it is unsurprising that they are more likely to meet their estimated dietary goals and experience improved nutrition status. As up to 20% of a patient’s nutrition status deteriorates in hospital, maintaining and improving nutrition status is an important focus for acute care facilities1.
With the Spoken Menu, foodservice staff are available to address patient’s complaints and concerns. The staff can also answer questions that the patient has, provide guidance on meal choices for their specific diet (such as a diabetic diet), and explain menu changes7. Furthermore, food quality scores typically increase with the Spoken Menu, even when no changes have been made to the menu. Researchers have suggested that the increased patient-staff interaction may also increase the patient’s perception of the food’s quality4,6,7.
Some studies have shown that employee job satisfaction increases with implementation of the Spoken Menu5. With the Spoken Menu, the nutrition assistant’s duties can change from office-based work to tasks that allow them to use their nutrition knowledge in assisting patients with their meal selections5.
Acute care facilities that have implemented the Spoken Menu see an increase in overall patient satisfaction, even when no other aspects of the meal service are changed. It has been suggested that the increased patient-staff interaction which occurs with the Spoken Menu improves patient satisfaction6,7.
Challenges Associated with the Spoken Menu:
The increased cost that comes with changing the foodservice model can be a challenge for many facilities. When transitioning to the Spoken Menu model, at a minimum foodservice and nursing staff must receive education and training. It may be deemed necessary to train other departments as well if they are involved in the meal routine. Training staff can be time-consuming and costly for organizations.
Changes must occur to job routines or workflow to allocate for the increased number of attendants required to take orders3,8. If labour is unable to be redistributed, the labour budget may need to be increased. Acute care facilities could experience logistical issues with receiving additional funding for labour, as there is a trend towards reducing labour costs.
While several studies have suggested that employee satisfaction increases with the implementation of the Spoken Menu, some acute care facilities have observed an increase in job dissatisfaction. With the Spoken Menu, staff who are taking orders at the bedside must deal with frustrated patients and family members. This can be emotionally taxing, and staff can experience burn out.
Facilities may need to purchase additional equipment to streamline the new foodservice system. Tablets can be an effective way to check patients’ diet and take their order. It is beneficial to use technology over a pen-and-paper method as the order is sent down to the kitchen as soon as the attendant takes the patients order. This allows for the meal to be delivered in a timely manner. However, there is a cost associated with purchasing new equipment and/or software. Furthermore, purchasing expensive equipment may require budget planning several years in advance.
Key Considerations when Implementing the Spoken Menu in Acute Care Facilities:
Based on the benefits and challenges that are associated with the Spoken Menu, below are several key considerations that should be kept in mind when implementing this foodservice model.
