What is the purpose of the must screening tool?
The primary purpose of the Malnutrition Universal Screening Tool (MUST) is to act as a standardized, five-step method for healthcare professionals to identify, assess, and develop a management plan for adults who are malnourished or at risk of malnutrition. Developed by the British Association for Parenteral and Enteral Nutrition (BAPEN), MUST is designed for universal applicability across various care settings, including hospitals, care homes, and community healthcare. By providing a consistent framework, MUST helps ensure that nutritional concerns are not overlooked, enabling timely intervention that can significantly improve patient recovery rates, shorten hospital stays, and reduce healthcare costs. It also includes guidance for addressing obesity, making it a comprehensive nutritional screening instrument.
The five steps of the MUST screening process
The MUST screening process is straightforward and relies on three key parameters to calculate a total score that indicates a patient's risk level. The final two steps guide the appropriate management plan.
- Step 1: Body Mass Index (BMI) Score. A patient's BMI is calculated using their height and weight. Different scores are assigned based on the BMI category, with lower BMI indicating a higher risk of malnutrition. If a patient is obese, this is also noted.
- Step 2: Unintentional Weight Loss Score. This step assesses the percentage of unplanned weight loss over the past 3-6 months. The assessor compares the current weight to a previous, known weight, and a higher percentage of weight loss results in a higher score.
- Step 3: Acute Disease Effect Score. A score is added if the patient is acutely ill and has had, or is likely to have, no nutritional intake for more than five days.
- Step 4: Overall Risk Score. The scores from the first three steps are added together. The total score categorizes the patient into a low, medium, or high-risk category for malnutrition.
- Step 5: Management Guidelines. Based on the overall risk score, healthcare professionals implement an appropriate care plan according to local policy. This can range from routine monitoring to immediate dietary referral.
The rationale for using MUST
The use of a standardized tool like MUST is crucial in a clinical setting for several reasons:
- Early Intervention: MUST allows healthcare providers to quickly screen a large number of patients, identifying those at risk early before their nutritional status significantly deteriorates.
- Improved Patient Outcomes: Addressing malnutrition promptly can lead to better patient outcomes, including faster recovery from illness or surgery, fewer complications, and a reduced risk of infection.
- Cost-Effectiveness: By preventing the adverse effects of malnutrition, such as prolonged hospital stays and re-admissions, MUST contributes to significant healthcare cost savings.
- Objective and Reliable: The tool uses objective, easy-to-measure parameters (BMI, weight loss) and has been validated for reliability across different healthcare settings.
MUST vs. Comprehensive Nutritional Assessment
It is important to distinguish between a screening tool like MUST and a full nutritional assessment. A screening tool is designed for quick identification, while an assessment provides a detailed diagnosis.
| Feature | MUST Screening Tool | Comprehensive Nutritional Assessment |
|---|---|---|
| Primary Goal | To identify potential nutritional risks quickly and efficiently. | To provide an in-depth evaluation and confirm the presence and extent of malnutrition. |
| Methodology | Five simple steps based on BMI, weight loss, and acute disease effect. | Includes a detailed dietary history, physical examination, anthropometric measurements, and lab tests. |
| Personnel | Can be performed by any trained healthcare staff, including nurses and assistants. | Requires a qualified registered dietitian or nutritionist (RDN). |
| Outcome | Categorizes risk as low, medium, or high, guiding the next steps. | Diagnoses the specific type of malnutrition and identifies underlying causes. |
| Time Commitment | Quick to complete, often taking only a few minutes. | Can be a lengthy process depending on the patient's condition. |
Management based on MUST risk level
Once a patient's risk level has been determined, the MUST guidelines provide clear recommendations for action.
- Low Risk (Score 0): Routine clinical care. Repeat screening on a scheduled basis (e.g., annually in the community, monthly in care homes, weekly in hospitals).
- Medium Risk (Score 1): Observe and document the patient's dietary intake for three days. If intake is adequate, continue routine screening. If inadequate, create a care plan to improve nutritional intake and monitor closely.
- High Risk (Score $\geq$ 2): Immediate referral to a dietitian or nutritional support team is typically recommended. A comprehensive care plan should be developed, implemented, and monitored closely to increase nutritional intake.
- Obesity: If the patient is obese but not at high risk of malnutrition, underlying conditions should be managed first. The presence of obesity is noted in the patient's records.
Application of MUST in various settings
One of the key strengths of the MUST tool is its versatility. It is designed to be applicable across different healthcare environments, ensuring a seamless approach to nutritional care.
- Hospitals: Screening is typically performed on admission and then weekly for low-risk patients. This helps in identifying malnutrition exacerbated by illness or surgery.
- Care Homes: Screening is conducted on admission and then monthly for low-risk residents. This addresses the common issue of malnutrition in the elderly population.
- Community: For at-risk groups, screening is recommended annually, such as during routine health checks. This supports proactive health management and prevention.
Conclusion: Ensuring proactive nutritional care
The purpose of the MUST screening tool is fundamentally to improve patient care by making the detection of malnutrition and nutritional risk a standard, universal practice. By providing a reliable, quick, and easy-to-use method, MUST empowers healthcare professionals across all settings to identify patients in need of nutritional support. Its systematic approach ensures that appropriate action, from routine monitoring to specialized dietetic intervention, is taken swiftly. While MUST is a powerful tool for screening, it serves as the crucial first step that precedes a more comprehensive nutritional assessment when needed, paving the way for better health outcomes and a more effective approach to nutrition diet and care. The widespread adoption of MUST exemplifies a proactive approach to managing the serious health consequences of malnutrition. For more information, refer to the resources provided by the British Association for Parenteral and Enteral Nutrition (BAPEN).
