EatSafe SG

What is EatSafe SG?

EatSafe SG is an initiative that aims to provide a common language for everyone involved in the care of individuals with swallowing difficulties (dysphagia) when communicating about dysphagia diets and modified fluids. Its main objective is to ensure safety for these individuals.

The Ministry of Health (MOH) Singapore Dysphagia Diet Standardisation Committee comprising nursing home leaders, speech therapists, dietitians, administrators, Agency for Integrated Care (AIC) representatives and medical advisor recommended the implementation of the International Dysphagia Diet Standardisation Initiative (IDDSI) framework across healthcare institutions and community care services in Singapore. The IDDSI Framework is a globally standardised framework of diet and fluid terminologies and descriptors to describe texture modified foods and thickened fluids used for individuals with dysphagia.

Why is EatSafe SG important?

Dysphagia can occur due to medical conditions like stroke, degenerative diseases and, in head and neck cancer. It is often associated with malnutrition, dehydration, chest infection and in some cases, even death.

Speech Therapists are healthcare professionals trained to assess and manage dysphagia via one or more of the following approaches:

• Rehabilitation (e.g., exercises to strengthen muscles used for swallowing)

• Strategies (e.g., adapted utensils or specific head/body postures when swallowing)

• Modification of food textures (e.g., pureed diet) and fluid thickness

Modification of diet and fluid is most commonly recommended. Previously, different healthcare institutions in Singapore use different terminologies to refer to texture-modified diet and fluids. For example, for the same diet level, terms like minced diet, chopped diet, soft moist textures were used.

Varied terminologies for diets and fluids pose great safety concern especially in the long-term care settings where residents are transferred from different healthcare institutions. This might inadvertently result in wrong diets being served and puts the patient at risk of choking.

The objectives of EatSafe SG are to:

1. Improve patient safety

2. Improve communication within and between healthcare professionals, healthcare providers and patients by reducing misunderstandings and ambiguity when communicating diet or fluid related information

3. Adopt standardised diet and fluid labels and descriptors when conducting and publishing research that is aligned to an international framework.

Who is involved in EatSafe SG?

Implementation of a national standardised diet and fluid terminology framework involves coordinated efforts from multiple stakeholders from numerous settings and institutions. This has so far included nearly 55,000 professionals who are involved in the care of patients with dysphagia, ranging from clinical staff to food preparation personnel.

Stakeholders involved across public and private sectors include:

• Speech therapists

• Dietitians

• Nurses and care assistants

• Food service and kitchen staff (e.g. chefs and food preparation personnel)

• Vendors (e.g. suppliers of raw ingredients, food products and thickener powder)

• Doctors (especially those directly involved in the care of individuals at risk of developing dysphagia)

• Other medical and healthcare professionals who should be made aware of the change

• Educational institutes (polytechnics, universities)

• Students (Speech Therapy, Nursing, Dietetics)

EatSafe SG Standards

All institutions involved in the care for patients/clients/residents with Dysphagia are required to ensure that all foods and drinks provided to dysphagic patients are prepared and served in a safe manner, which shall include ensuring that the food or drink:

1. Is prepared and served in accordance with the IDDSI diet level the patient is screened or assessed to require; or

2. Is prepared and served to that patient in accordance with an alternative IDDSI Diet level(s) as specified in the diet conversion table

A diet conversion table may be used to map to the most appropriate diet when patients transit to the next care setting if the recommended diet is not available

^{*Most patients are safe on both Pureed and Liquidised diet, unless stipulated by Speech Therapists. If patients/residents are only safe on either Pureed or Liquidised diet, this would be clearly documented in any communication, e.g., handover/memo.}  

Please refer to the relevant licensing terms and conditions under the Healthcare Services Act (HCSA) or service requirements on EatSafe SG standards for your institution.

The National Training Framework in the EatSafe SG Guide should be used as reference for competencies required for personnel involved in providing care to patients with dysphagia.

Details of training courses may be found under EatSafe SG guide in “Useful resource and links”. Refer to “Useful resources and links” for food preparation and educational resources.

For any enquires about EatSafe SG, please email eatsafesg@moh.gov.sg

Useful resources and links

Access essential tools and reference materials for EatSafe SG here