Full Goal

During meal consumption with minimal verbal cueing for safe swallowing strategies (chin tuck, controlled bolus size), patient will tolerate IDDSI Level 6 (soft and bite-sized) solids with no overt signs of aspiration across 3 consecutive meal observations, as measured by SLP clinical observation during meals.

Individualization Guidance

Before using this goal, verify:

• Current diet level. Document the patient’s baseline diet (e.g., IDDSI Level 4 pureed) and the clinical rationale for advancing to Level 6.
• Instrumental findings. If MBSS or FEES data is available, reference specific findings that support this advancement target. Bedside observation alone may not capture silent aspiration.
• Compensatory strategies specified. “Chin tuck, controlled bolus size” are placeholders. Replace with the specific strategies this patient uses and has demonstrated benefit from.
• “No overt signs of aspiration” is a clinical threshold. This means no coughing, no wet vocal quality, no throat clearing during or after swallowing. Document what you monitor.
• Meal context. Note the time of day, patient positioning, alertness level, and who supervised the meal. Medication effects on alertness may influence performance.

Clinical Notes

IDDSI Level 6 (soft and bite-sized) requires foods that can be mashed with a fork and are cut to 1.5cm pieces for adults. This goal is appropriate when the patient demonstrates safe swallowing on the current texture with compensatory strategies and the clinical question is whether they can tolerate the next level.

The “3 consecutive meal observations” criterion provides payer-defensible evidence of consistency. If the patient passes 2 meals but fails on the 3rd, the count resets — that variability is clinically meaningful and should be documented.

This goal does NOT include liquid consistency. If the patient is also advancing liquids, write a separate goal with its own criteria.