Malnutrition screening

Gastro Training — Wed, 28 Jul 2010 11:23:13 +0000

Discuss the MUST tool for malnutrition screening?

Malnutrition Universal Screening Tool (‘MUST’) is an evidence based tool designed to identify adults, who are malnourished, at risk of malnutrition (undernutrition), or obese. NICE 2006 recommends the use of MUST

MUST has been developed for use in

All adults (sick and healthy)
Hospital inpatients
Outpatients
In the community

MUST is a five step screening tool;

Step 1

Measure height and weight to get a BMI score. If unable to measure height and/or weight, use alternative procedures;

If height cannot be measured
Use recently documented or self-reported height (if reliable and realistic).
If the subject does not know or is unable to report their height, use one of the alternative measurements to estimate height (ulna, knee height or demispan).
If height & weight cannot be obtained
Use mid upper arm circumference (MUAC) measurement to estimate BMI category.

Step 2
Note percentage unplanned weight loss and score using tables provided.
If recent weight loss cannot be calculated, use self-reported weight loss (if reliable and realistic).

Step 3
Establish acute disease effect and score.

Step 4
Add scores from steps 1, 2 and 3 together to obtain overall risk of malnutrition.

Step 5
Use management guidelines and/or local policy to develop care plan.

Step 1 BMI score	Step 2 Weight loss score	Step 3 Acute disease effect score
BMI (kg/m2) Score >20 0 18.5-20 1 <18.5 2	Unplanned Wt loss in past 3-6 m % Score <5 0 5-10 1 >10 2	If pt is acutely ill and there has been or is likely to be no nutritional intake for > 5 days Score 2
Step 4 Overall risk of malnutrition Add scores together to calculate overall risk of malnutrition Score 0 Low risk Score 1 Medium risk Score 2 or more High risk
0 Low Risk Routine clinical care Repeat screening at weekly intervals in hospital	1 Medium risk Observe Document dietary intake for 3 days If improved or adequate intake- little clinical concern. If not- follow local policy Repeat screening weekly	2 or more High risk Treat Refer to dietician or NST

Step 1
BMI score

Step 2
Weight loss score

Step 3
Acute disease effect score

BMI (kg/m2)   Score
>20                  0
18.5-20            1
<18.5               2

Unplanned Wt loss in past 3-6 m
%                                   Score
<5                                    0
5-10                                 1
>10                                  2

If pt is acutely ill and there has been or is likely to be no nutritional intake for > 5 days

Score 2

Step 4
Overall risk of malnutrition
Add scores together to calculate overall risk of malnutrition
Score 0 Low risk Score 1 Medium risk Score 2 or more High risk

0
Low Risk
Routine clinical care
Repeat screening at weekly intervals in hospital

1
Medium risk
Observe

Document dietary intake for 3 days
If improved or adequate intake- little clinical concern. If not- follow local policy
Repeat screening weekly

2 or more
High risk
Treat
Refer to dietician or NST

Ref

http://www.bapen.org.uk/musttoolkit.html

Gastroenterology Education and CPD for trainees and specialists » Malnutrition Screening

Malnutrition screening