Is IDDSI Mandatory? The short answer is “No”. The nuanced answer is “not explicitly”. The longer answer is that IDDSI is THE (only) current professional standard of practice for dysphagia diets and all federally regulated facilities need to follow professional standards of practice.
I believe that adopting IDDSI is mandatory if you are following current standards of professional practice. I know this is an unpopular opinion, but here is my argument.
What is the definition of Current Professional Standards of Practice?
CMS regulates facilities and they issue extensive documents to operators and regulators. Here’s the definition of “Current professional standards of practice” from the State Operators Manual Guidance to Surveyors for Long-Term Care Facilities:
“Current professional standards of practice” refers to approaches to care, procedures, techniques, treatments, etc., that are based on research and/or expert consensus and that are contained in current manuals, textbooks, or publications, or that are accepted, adopted or promulgated by recognized professional organizations or national accrediting bodies.
I was curious about how important this definition is within the entirety of the Guidance document, so I searched for the term “professional standards of practice”.
“Professional standards of practice” are found in 101 places outside of the definition.
The concept of professional standards of practice does indeed seem to be a fundamental part of the guidance CMS is giving to surveyors.
What does IDDSI say?
This is IDDSI’s current answer to the question of whether IDDSI is mandatory or not:
Implementation of IDDSI is not mandatory and the IDDSI Board of Directors has always been clear that while we hope the global community will embrace IDDSI for the safety of those with dysphagia, it is not mandatory. That being said, some countries, regions or health authorities may mandate adoption to ensure consistent implementation of IDDSI.
Source – https://iddsi.org/FAQ/. Accessed 8/27/2024
IDDSI is not officially mandatory, but they recognize that it may become mandatory in specific jurisdictions. And they are not opposed to IDDSI being a mandatory standard of practice.
What is the evidence backing IDDSI?
I checked in with a colleague on the US IDDSI Reference Groups’s research committee. They initially sought to catalog every article that used IDDSI. A few years ago, that amounted to a few new articles each month. But the use of IDDSI in research exploded and they couldn’t keep up with the number of new articles each month. They abandoned the effort after documenting more than 550 articles that utilized IDDSI.
What do professional organizations say?
In the USA, the 3 main professions involved with dysphagia diets are dietitians, speech therapists and dietary managers.
The professional organizations representing these professions are the Academy of Nutrition and Dietetics (AND), the American Speech-Language-Hearing Association (ASHA) and the Association of Nutrition and Foodservice Professionals (ANFP).
All 3 organizations endorse IDDSI as the dysphagia diet they support:
AND have supported IDDSI since the official launch of IDDSI in the USA – in May 2019. AND also fully transitioned their Nutrition Care Manual to IDDSI in October 2021. IDDSI is the only dysphagia diet supported by AND. https://www.eatrightpro.org/practice/dietetics-resources/post-acute-and-long-term-care-management/international-dysphagia-diet-standardization-initiative
ASHA has endorsed IDDSI since the official launch of IDDSI in the USA – in May 2019. https://www.asha.org/slp/healthcare/international-dysphagia-diet-standardisation-initiative/
ANFP doesn’t appear to have an explicit endorsement on their website. However, their support is mentioned by both ASHA and AND on their websites.
The AND was the publisher of the previous standards in the US – the National Dysphagia Diet (NDD)– and they have ended support of the NDD as of October 2021 when the Nutrition Care Manual transitioned to IDDSI.
What alternative diets are out there?
The only other option over the last ~20 years has been the National Dysphagia Diet. However, professional organizations have switched their support to IDDSI, the organization that published it has withdrawn support, and the scientific community isn’t using the NDD in publications often these days.
Is IDDSI the Current Professional Standard of Practice?
Let’s return to the definition of Current professional standards of practice and evaluate whether IDDSI is the current standard of practice.
“Current professional standards of practice refers to approaches to care, procedures, techniques, treatments, etc…”
IDDSI is an approach to care and procedures.
“...that are based on research and/or expert consensus…”
IDDSI is research-based
“…and that are contained in current manuals, textbooks, or publications, …”
IDDSI is the current standard in dozens of publications each month
“…or accepted, adopted or promulgated by recognized professional organizations or national accrediting bodies.”
IDDSI is the only dysphagia diet that is accepted, adopted and promulgated by the three main professional organizations in the US – AND, ASHA and ANFP.
Is there an Alternative Current Professional Standard of Practice?
The National Dysphagia Diet, published in 2002, was the de facto previous professional standard of practice. However, the organization that published it, the Academy of Nutrition and Dietetics, endorsed IDDSI in 2019, transitioned the Nutrition Care Manual to IDDSI in 2021, and ceased printing the publication.
If there is another dysphagia diet in use in the USA right now that meets all of the criteria of a current professional standard of practice, I’m not aware of it.
Conclusion
When anyone asks me whether IDDSI is mandatory, I have started saying that it isn’t technically mandatory, but it is the current standard of professional practice and I don’t know of any other diet that you could reasonably defend to a surveyor.
To me, IDDSI is mandatory.
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