Unlike many previous tools, MUST is designed to be user-friendly, making it suitable for routine use in both hospitals and the community for clinical and public health purposes, and even self-screening [3. It comprised literature reviews of surveys and researchers' own national prevalence surveys; clinical intervention and experimental starvation studies; and assessments of the link between malnutrition and complications and resource consumption in hospitals and the community.
The studies demonstrated excellent inter-rater agreement associated with MUST screening, examined the relative value of different surrogate measures for estimating height and weight status in bed-bound patients and devised new predictive equations to estimate height from ulna length at the bedside.
It also established the predictive validity of MUST with respect to clinical outcomes, such as mortality and length of stay in hospital, and healthcare use in nationally representative samples of older people living in the community [3. MUST used these factors to formulate a simple, valid, reproducible score that formed the basis of a care plan. Its efficacy was then demonstrated through another series of studies, including field testing in more than centres throughout the UK.
For bed-bound patients, for whom weight and height cannot readily be measured, the research demonstrated that alternative measures e. Br J Nutr ; Nutritional screening for adults: a multidisciplinary responsibility.
ISBN 1 70X. An analytic appraisal of nutrition screening tools supported by orginal data with particular reference to age. Nutrition ; 28 5 Malnutrition self-screening by using MUST in hospital outpatients: validity, reliability, and ease of use.
After the first audit period, an educational session on MUST was delivered to all staff working on the vascular surgical ward. This was in addition to a Trust-wide initiative aimed at improving nutritional assessment of inpatients. After a subsequent two-month period, the study was repeated in a cohort of inpatients on the vascular ward. Data are presented as median interquartile range, IQR. The initial assessment of the use of the MUST tool in vascular surgical patients highlighted the fact that it was underutilised and few patients were referred for nutritional support.
In the second cycle of the study, the study team, who had been educated in the use of the MUST tool, undertook nutritional screening on a group of patients who had not previously been MUST scored by ward staff. This highlighted a number of patients who required nutritional support.
The study team then trained all the vascular surgical ward staff doctors and nurses in the use of the MUST tool and stressed that all patients should undergo MUST scoring on admission to the ward if it had not already been completed at the time of pre-operative assessment.
It has also been incorporated in a trust-wide initiative to improved nutritional screening. Reasons for admission are shown in Table 1. No patients in this subgroup were referred for nutritional support or dietetic assessment. Two patients in this subgroup achieved MUST scores of 2 or more and both were referred for nutritional support and feeding assistance. Neither patient had received additional nutritional support by the time of completion of data collection. Weight loss and acute disease score were correctly recorded in all those screened in the N-MUST subgroup.
Overall MUST score was recorded in 42 patients and weight loss was correctly recorded in all. Additional nutritional support had not been received by the time of completion of data collection. Vascular patients are a co-morbid subset of patients who may be at high risk for malnutrition and developing postoperative complications. This study highlighted the importance of proper education, training and utilisation of nutrition screening tools and the need for appropriate referrals to be made and followed-up if malnutrition was identified.
After a targeted educational session, the use of MUST on vascular wards improved. However, MUST screening in pre-operative assessment clinics was still not being performed. In addition, some patients were still incorrectly scored and the referrals which should have been triggered by the MUST score were not initiated.
However, there is little data on the prevalence of malnutrition amongst vascular surgery patients thereby justifying our interest in this cohort of patients. Additionally, the educational session had not been provided to pre-operative assessment staff and this may account for the failure of improvement in their performance.
This study highlighted the importance of appropriate education and training among clinical ward staff. Furthermore, clinicians should ensure appropriate utilisation of nutrition screening tools, such as MUST, and that appropriate specialist dietetic referrals were made and followed-up if malnutrition was identified.
Declaration of interests: Nothing to declare. National Center for Biotechnology Information , U. It is now recommended that all hospital and care facility patients in the UK should be screened for malnutrition within 48 hours of admission and that a nutrition care plan part of the tool is put into action as a result.
Screening should be repeated at weekly intervals in the acute sector and monthly in the chronic care setting. The development, validation and reliability of a nutrition screening tool based on the recommendations of the British Association for Parenteral and Enteral Nutrition. Clinical Nutrition ;
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