What is the purpose of the MUST tool?
The primary purpose of the Malnutrition Universal Screening Tool (MUST), developed by BAPEN, is to offer a consistent, swift, and user-friendly method for healthcare professionals to evaluate an adult patient's nutritional status across various settings like hospitals and community care. By screening for risk factors, MUST aids in the early detection of malnutrition, undernutrition, and obesity. Detecting malnutrition early is vital as it can lead to worse health outcomes, including more complications and longer hospital stays.
Identifying patients at medium or high risk through the MUST assessment enables healthcare teams to intervene early, preventing potential health decline and allowing for the implementation of personalized nutritional care plans. This focused approach ensures efficient allocation of resources to patients who need them most.
How the MUST tool works: The 5-step process
The MUST tool utilizes a straightforward, five-step process for trained healthcare staff to assess nutritional risk.
- Calculate the BMI Score: This step involves determining the patient's Body Mass Index (BMI) from their height and weight. A score is assigned based on the BMI value, for instance, a BMI under 18.5 kg/m² scores 2, between 18.5 and 20 kg/m² scores 1, and over 20 kg/m² scores 0.
- Note the Weight Loss Score: The second step considers unplanned weight loss over the last 3 to 6 months. Losing more than 10% of weight scores 2, 5% to 10% scores 1, and less than 5% scores 0.
- Assess Acute Disease Effect Score: Step three assigns a score of 2 if a patient is acutely ill and is likely to have no nutritional intake for over five days.
- Calculate the Overall Risk Score: The scores from the first three steps are totaled to determine the patient's malnutrition risk level: low (score 0), medium (score 1), or high (score ≥ 2).
- Use Management Guidelines: Based on the risk category, healthcare professionals follow specific management guidelines, which for high-risk patients often includes referral to a dietitian.
Subjective assessment and alternative measurements
When accurate height or weight measurements are not possible, such as with immobile patients, the MUST tool permits alternative methods or subjective assessments. These can include estimating height using ulna length, using reliable self-reported weight, or employing clinical judgment based on the patient's physical appearance.
Comparison: MUST vs. Other Screening Tools
While MUST is a widely used screening tool, particularly in the UK, other tools like the Patient-Generated Subjective Global Assessment (PG-SGA) and the Mini Nutritional Assessment-Short Form (MNA-SF) are also utilized. Each tool has its unique focus and method:
| Feature | MUST Tool | PG-SGA | MNA-SF |
|---|---|---|---|
| Target Population | Adults | Cancer patients (primary) | Elderly patients |
| Assessment Items | BMI, recent weight loss, acute disease effect | Weight history, food intake, nutrition impact symptoms, functional status | Questionnaire on general health, food intake, mobility, BMI, etc. |
| Primary Use | Rapid screening for malnutrition risk | Comprehensive nutritional assessment and triage | Screening and assessment of malnutrition risk |
| Ease of Use | Simple, quick (approx. 2-4 mins) | More detailed and time-consuming | Relatively simple and quick to administer |
| Outcome Measures | Low, medium, or high malnutrition risk | Well-nourished, moderately or severely malnourished | Well-nourished, at-risk, or malnourished |
The crucial role of nutrition diet in patient management
Following a MUST assessment, the determined risk category guides the patient's nutritional care plan. Management guidelines offer direction on the appropriate level of intervention.
- Low Risk (Score 0): These patients receive routine care and are rescreened periodically.
- Medium Risk (Score 1): Patients require observation of dietary intake, and if insufficient, a care plan is developed. More frequent rescreening is also necessary.
- High Risk (Score ≥ 2): Immediate action and intensive support are needed for high-risk patients, often involving a dietitian to set goals and implement dietary strategies such as food fortification or supplements.
The MUST tool encourages the integration of nutritional considerations into overall patient management, promoting a proactive approach. Adequate nutritional support is fundamental for recovery, helping to reduce complications and enhance immune function.
Conclusion
To summarize, the purpose of the MUST tool is to serve as an efficient and reliable method for screening adults for malnutrition risk across diverse healthcare environments. Its five-step process simplifies assessment, allowing professionals to quickly categorize patients based on BMI, weight loss, and acute illness. This facilitates timely, targeted interventions and appropriate nutritional support, ultimately improving patient outcomes and optimizing resource use. While valuable for screening, it should be used in conjunction with clinical judgment.
Further Resources
For more detailed information on the MUST tool, refer to the official resources provided by its developer, BAPEN (the British Association for Parenteral and Enteral Nutrition), at their website: https://www.bapen.org.uk/
Key aspects to remember about the MUST tool
- Standardized Screening: Provides a uniform method for assessing malnutrition risk in adult patients.
- Five-Step Process: Uses simple, manageable steps for assessment by trained staff.
- Early Intervention: Enables timely nutritional intervention through early identification of risk.
- Categorized Management: Guides specific management plans based on low, medium, or high risk.
- Universal Applicability: Designed for use in hospitals, care homes, and community settings.
