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Nutritional screening is a quick, simple procedure that should be undertaken during the first meeting with the patient. Best practice is to undertake this screening as part of the admission or inital assessment of a person and that it is completed within the first 24 hours of arriving in a care setting. This review should be undertaken by a doctor, a registered nurse, or an HCA. It is critical for the early identification of the existence or high risk of malnutrition. Using an accredited screening tool, such as the 'Malnutrition Universal Screening Tool' ('MUST') raises the awareness of a patient's risk of malnutrition.
If screening is not undertaken, patient safety may be compromised.
If a problem is identified on screening, a formal nutritional assessment - a detailed and more specific in-depth evaluation of a person's nutritional status - is conducted by those with nutritional expertise, such as a specialist nutrition nurse or a dietitian.
Basic nutritional screening
Malnutrition is often unrecognised, but with the use of effective screening, not only are malnourished patients identified and treated, but the burden on health resources can be better managed. Effective management of malnutrition reduces the burden on health and care resources from delayed recovery and complications. About 40% of people who are admitted to hospital or care homes are malnourished (BAPEN report, 2008). Regular screening is the only way that malnourished individuals can be identified and appropriate action taken.
There are many signs and symptoms that in combination may indicate that a patient is malnourished. What signs and symptoms have you identified or consider might indicate a person is at risk of being malnourished?
Select the link - Activity: Signs and symptoms of malnutrition (PDF 313KB). Follow the instructions to complete the activity. This document is in PDF format so that you can save to your computer. You may wish to upload it to your e-Portfolio as evidence of your learning and edit it at a later date.
What happens in your care setting?
In the section Supporting and assisting people you will find an activity which involves preparing an action plan to help you to do something about any issues that have been raised for you during your learning. You may wish to include actions based on your answers to these questions:
- What nutritional assessment tool does your organisation use?
- Do you feel competent to use the tool?
- Who provides training in the use of this tool?
- Is the tool used on a consistent basis and is action taken to review a person's nutritional status?
Ideally, people should be screened using a validated tool. The 'Malnutrition Universal Screening Tool' ('MUST') is the most commonly used screening tool and is reproduced here with the kind permission of the British Association for Parenteral and Enteral Nutrition (BAPEN). For further information on 'MUST' follow the link to the BAPEN website. 'MUST' can be used in any clinical setting for adults. Follow the link on the BAPEN website to find some practical resources in the 'MUST' Toolkit.
'MUST' has been designed to assist with the identification of adults who are underweight and at risk of malnutrition, as well as those who are obese. It has not been designed to detect deficiencies in or excessive intakes of vitamins and minerals. It has five steps:
- Measure height and weight to calculate the person's Body Mass Index (BMI)
- Establish whether the person has lost any weight unintentionally
- Establish the effect of the person's illness on their ability to eat and drink
- Add up the scores to assess if the person is malnourished
- Agree the person's care plan and monitor regularly.
Download a practical explanatory guide for How to use 'MUST' (PDF 907KB).
To use 'MUST', you need to undertake training and be assessed as competent in the application of the tool. This training and assessment is often undertaken by senior nurses or dieticians.
Find out who can provide this training for you in your workplace.
Download a Practical Workshop for using 'MUST' (PDF 85KB) that can be completed in pairs under the direction of a qualified trainer.
Key learning point
Whatever method or tool is used to assess people's nutritional status, it is vital that the assessment is conducted as a priority after a person is admitted to a care setting and that the subsequent actions are undertaken immediately and reviewed at regular and appropriate intervals.