Nutrition - nutritional assessment

Malnutrition requires active screening and assessment in order for appropriate action to be taken. Evidence based guidelines on nutrition recommend the use of nutritional screening in acute and community settings (National Institute for Health and Clinical Excellence 2006). The BAPEN Quality Group advocate the use of planned care pathways for all service users to ensure a more consistent service and reduce variations in care (Brotherton et al 2011).

Seven step approach

BAPEN (British Association for Parenteral and Enteral Nutrition) advocate a seven step approach to care pathways that "should use the simplest, sustainable, effective treatment that allows maintained autonomy and independent living, if possible" (BAPEN 2012, p.21).

Step one: recommends the use of a validated screening tool such as the Malnutrition Universal Screening Tool (MUST) (BAPEN 2003). A considerable amount of work has been underatken to validate MUST. It has been shown to have real prognostic value when screening for nutritional risk in older patients (Henderson et al 2008).

Steps two to five: identify the possible interventions that may be taken to address malnourishment or those at risk of malnourishment.

Step six: relates to the importance of documentation for screening and subsequent assessments including action plans and treatment goals. It also highlights the need for that information to be made available to subsequent providers if the patient is transferred to another care setting.

Step seven: looks at the importance of regular review of care pathways including feedback from service users.

Implementing evidence-based screening tools can be done despite pressures on nursing staff (Bailey 2006). However any change programme needs to address potential barriers including nursing staff time and knowledge (Raja et al 2008).

Studies point to the need for training, increased feedback regarding screening practice, leadership and attention to ways of embedding screening and assessment into everyday practice (Bailey 2006, Raja et al 2008).

References

The online resources were last accessed on 7 December 2012. Some of them are in PDF format - see how to access PDF files.

Bailey R (2006) Implementing nutrition screening. Nursing Management13(3) June pp.20-24.

BAPEN (2012) Toolkit for commissioners and providers in England: Malnutrition matters. Meeting quality standards in nutritional care, 2nd ed. (PDF 4.6MB), Redditch: BAPEN.

Brotherton A et al (2011) Malnutrition is dangerous: the importance of effective nutritional screening and nutritional care. Clinical risk 17(4) July pp.137-142.

Henderson S et al (2008) Do the malnutrition universal screening too (MUST) and Birmingham nutrition risk (BNR) score predict mortality in older hospitalised patients? BMC Geriatrics 8(26) October.

National Institute for Health and Clinical Excellence (2006) Nutrition support in adults: oral nutrition support, enteral tube feeding and parenteral nutrition, CG32. London: NICE.

Raja R et al (2008) Nurses' views and practices regarding use of validated nutrition screening tools. Australian Journal of Advanced Nursing 26(1) Sep-Nov pp. 26-33.