Malnutrition Universal Screening Tool (MUST)
Identifies patients who are malnourished or at risk of malnutrition.
Use in patients ≥18 years old. May be applied in either a hospital or community setting.
Per BAPEN guidelines, patients should be screened as follows:
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Low risk (MUST Score = 0) patients should have routine repeat screening according to the clinical setting:
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Hospital – weekly.
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Care homes – monthly.
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Community – annually, for special groups (e.g. those >75 years old).
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For medium risk (MUST Score = 1) patients, formally document dietary intake for 3 days if patient in hospital or care home. If improvement in the patient’s dietary intake and little clinical concern, then documentation may be discontinued.
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If there is no improvement with intake and/or clinical concern by staff, then dietician referral can be considered. Continue repeat screening as follows:
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Hospital – weekly.
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Care home – at least monthly.
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Community – at least every 2-3 months.
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For high risk (MUST Score ≥2) patients, refer to dietician in hospital or community dietician support team. Increase and document overall nutritional intake. Monitor and review care plan as follows:
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Hospital – weekly.
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Care home – monthly.
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Community – monthly.
Even though increasing scores correlate with increased risk, clinical circumstances exist where lower scores are still very high risk, e.g. anorexia nervosa.
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For patients requiring nutritional support in hospital, a dietician should be involved at an early stage.
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Nutritional support can be categorized as oral nutritional supplements, enteral tube nutrition, and parenteral nutrition. Again, these methods are prescribed and monitored under specialist supervision, especially in the case of critically ill patients.
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For all risk categories, treat any underlying conditions while optimizing nutritional status. Record need for special diets, and provide help and advice on food choices, eating, and drinking when necessary.
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Always record the presence of obesity.