Malnutrition Universal Screening Tool MUST

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					                                       MUST
                        Malnutrition Universal Screening Tool


„MUST‟ is a five-step screening tool to identify adults, who are:
 malnourished,
 at risk of malnutrition (under nutrition), or
 obese.
It includes management guidelines which can be used to develop a care plan.
It is for use in hospitals, community and other care settings and can be used by all care workers.
Re-assess individuals identified at risk as they move through care settings.
Developed by Malnutrition Advisory Group (MAG) A Standing Committee of B A P E N.
If unable to obtain height and weight, alternative measurements are available from www.bapen.org.uk




         STEP 1 BMI                       STEP 2 Weight Loss                   STEP 3 Acute Disease
                                        (Unplanned wt loss in 3-6          If patient is acutely ill   =2
BMI > 20.0 (>30 obese+) = 0                     months)                    and there has been or is
BMI 18.5 – 20.0         =1           Wt loss <5%                 =0        likely to be no nutritional
BMI < 18.5              =2           Wt loss 5-10%              =1         intake for >5 days
                                     Wt loss >10%               =2



                                           Add all scores



                                  STEP 4 Risk of Malnutrition
            0                                 1                                  2 or more
         LOW RISK                      MEDIUM RISK                               HIGH RISK

   ROUTINE CLINICAL                  OBSERVE & MONITOR                              TREAT
        CARE



                                         STEP 5
                                    RECORD SCORE AND
                                     START CARE PLAN



             Review all patients discharged from hospital on supplements within 4 weeks to update
Important
             MUST score and care plan.
       M.U.S.T. Step 5 – Community Management Guidelines

                Information for Nursing/Care Homes/Carers
 Please contact the Department of Speech and Language Therapy (01803 654931) if there are any
 concerns about swallowing or dysphagia.

      Score = 0       Cater for special diets as required.
      Low Risk        Repeat screening monthly.



                      Monitor oral intake. Document dietary intake for 3 days (minimum).
                      Encourage foods/snacks high in energy and protein. Contact GP or the Dietetics
                       Department for copies of leaflets, for example “Making the Most of Your Food” and
                       “Calorie Boosters and Meal Plan Suggestions”.
    Score = 1
                      Encourage the use of Build Up and Complan drinks available from larger
   Medium Risk*        supermarkets/pharmacies (max. 3/day).1
                      Weight loss may be an indication of an underlying condition. Liaise with GP to
                       initiate any medical investigations as appropriate.
                      Treat any underlying conditions, which may affect oral intake (e.g. nausea, vomiting,
                       constipation, diarrhoea, low mood).
                                       Review within 2-4 weeks and check MUST score.
                                          Is oral intake poor or weight decreasing?

                  Yes                                                              No


         Follow high risk                                Continue until weight/appetite back to target.
          guidelines                                      Repeat risk score monthly in care home.

             ¹ Unless contraindicated e.g. diabetes, renal disease. Contact dietitian for advice.


                              Follow medium risk guidelines and add in the following care:
                      Encourage foods/snacks high in energy and protein.
   Score >2 High      Discuss with GP whether appropriate to:
       Risk*                   trial nutritional supplement (sip feed)
                               make referral to the Department of Nutrition and Dietetics.
                         Review in one month and repeat risk score. Is there progress towards goals?

                   Yes                                                                  No



     Re-enforce dietary advice, as required                    Review treatment plans with GP
     As progress continues, gradually decrease
      supplements under guidance of GP.
     Continue to monitor until goals achieved.

*Unless detrimental or no benefit is expected from nutritional support e.g. imminent death.
Please contact the Department of Nutrition and Dietetics if you would like further advice.
Torbay Hospital, Torquay TQ2 7AA Tel 01803 654 380