IDDSI Levels: Dysphagia Diet Standardization in Foodservice

What are IDDSI levels?

While massive multi-site healthcare systems are becoming the norm, individual facilities often maintain different foodservice methods and recipes. IDDSI levels present an opportunity to measure and standardize a vital aspect of patient nutrition.

IDDSI stands for International Dysphagia Diet Standardisation Initiative. It is a global mission to establish consistency among the terminology, definitions, and parameters surrounding solid and liquid foods. IDDSI levels utilize numbers to represent food texture (3 – 7) and drink thickness (0 – 4).

A graphic depicting a team testing IDDSI levels

Dysphagia is essentially difficulty swallowing, correlating to a higher risk of choking. Therefore, offering appropriate items to such patients is imperative to maximize safety and reduce risks. By adhering to the IDDSI framework, food and nutrition services staff avoid guesswork.

Ten Ways to Begin Implementing IDDSI

Every facility’s experience will differ based on its operation, data, current dysphagia setup, and patient diets. However, the following guidelines should provide a foundation for the journey toward IDDSI implementation.


Assemble a team and narrow it down to a few key players to avoid gridlock when making decisions.


Consider using nutrition software if you do not already have something in place. Maintaining a single source of data for ingredients, methods, recipes, restrictions, menus, and diet orders is ideal.


Identify IDDSI levels and compare them with your current dysphagia restrictions.


Test all dysphagia recipes. (More on this in the next section!)


Note any necessary changes to recipes and/or recipe restriction linking.


Determine a strategy (i.e., edit existing dysphagia restrictions and recipe linking vs. add new) and timeline (goal for going live with IDDSI).


Educate staff, communicate upcoming changes, and enforce proper IDDSI levels usage. Some notable groups include:


Edit/build menus in software for dysphagia diets as necessary.


Test any substitution automation with the updated linking, menus, and restrictions.


Continue to assess and record IDDSI levels for added items moving forward.

How do I determine IDDSI levels?

Various testing methods involve syringes, forks, spoons, chopsticks, and fingers to evaluate IDDSI levels. Furthermore, it is crucial to replicate the actual preparation and serving methods. For instance, if the kitchen is cook-chill and the average tray delivery time is twenty minutes, mimic those factors in the test environment.

During Computrition’s Virtual User Conferences (VUCs), we had the privilege of welcoming Peterborough Regional Health Centre, a star customer. Watch the firsthand footage below to see Christy Daley (Manager of Nutrition Services) and her team in action!

Where do I find resources? contains a plethora of helpful resources: definitions, framework, testing methods, implementation guides, patient education – the list goes on!

It is also a great idea to network with fellow nutrition professionals who can share their experience with IDDSI levels. Certain industry events serve as fantastic opportunities to connect with other hospitals and health systems. For example, our VUCs occur annually and are a complimentary resource for Computrition customers. Learn more by visiting our website or emailing our Account Relationship Management (ARM) team at

To discover how nutrition software can assist with IDDSI implementation and management, contact