The Malnutrition Universal Screening Tool, universally known as 'MUST', is a cornerstone of nutritional care within the Irish healthcare system. Endorsed by the Health Service Executive (HSE), this simple yet effective screening tool helps healthcare professionals identify, and subsequently manage, adults who are malnourished, at risk of malnutrition, or obese. Its widespread adoption ensures a consistent and proactive approach to patient nutrition, which is critical for positive health outcomes.
The 5-Step MUST Assessment
The MUST assessment is a systematic, five-step process designed to be easy for any trained care worker to perform. The first three steps are used to gather data, which is then used to determine the overall risk score in step four. The final step involves implementing a management plan based on this score.
Step 1: Calculate the BMI Score
The first step involves measuring the patient's height and weight to calculate their Body Mass Index (BMI). Scores are assigned based on the BMI value:
- BMI > 20 kg/m² (or > 20 kg/m² if age > 65): Score 0
- BMI 18.5 – 20 kg/m²: Score 1
- BMI < 18.5 kg/m²: Score 2
If accurate height and weight measurements are not possible, alternative methods such as measuring mid-upper arm circumference (MUAC) can be used. Special considerations are made for specific patient groups, such as those with fluid disturbances or amputations.
Step 2: Calculate the Weight Loss Score
This step assesses the patient's percentage of unplanned weight loss over the last 3-6 months. Healthcare providers compare the patient's current weight to their previous weight and assign a score:
- Unplanned weight loss < 5%: Score 0
- Unplanned weight loss 5–10%: Score 1
- Unplanned weight loss > 10%: Score 2
If previous weight records are unavailable, a realistic self-reported weight can be used, with an acknowledgement of the potential for reduced accuracy.
Step 3: Assign the Acute Disease Effect Score
An acute disease effect 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. This factor is given a score of 2, regardless of the individual's BMI or weight loss. This accounts for the rapid deterioration in nutritional status that can occur during a severe illness.
Step 4: Determine the Overall Risk Score
By adding the scores from the first three steps, a total MUST score is calculated. This score categorizes the patient into a specific risk level:
- Score 0: Low Risk of malnutrition
- Score 1: Medium Risk of malnutrition
- Score 2 or more: High Risk of malnutrition
Step 5: Implement the Management Plan
Based on the risk level determined in Step 4, healthcare staff follow HSE and local guidelines to create an appropriate care plan. This may range from simple monitoring for low-risk patients to a full dietitian referral for those at high risk.
HSE Adoption and Nutritional Management
The HSE has been instrumental in embedding the MUST tool into standard practice, developing policies and toolkits to ensure consistent application across acute hospitals and community care settings. The tool acts as the crucial initial step in a wider nutritional care process. For medium and high-risk patients, the resulting management plan is a key component of their overall care. This can include:
- Dietary Modifications: Providing fortified foods, snacks, and oral nutritional supplements to increase calorie and protein intake.
- Monitoring: Regularly re-screening patients (e.g., weekly in acute settings, monthly in care homes) and tracking changes in weight and food intake.
- Referral: Referring high-risk patients to a dietitian or specialist nutrition support team for a more comprehensive assessment and tailored intervention.
- Underlying Cause Investigation: Addressing any root causes of poor nutrition, such as difficulty swallowing, pain, or social factors.
MUST vs. Other Nutritional Screening Tools
While MUST is a leading tool in many settings, other options exist. The choice of tool can depend on the specific patient population, such as the Mini Nutritional Assessment (MNA) for older adults.
| Feature | Malnutrition Universal Screening Tool (MUST) | Mini Nutritional Assessment (MNA) | Other Tools (e.g., NRS-2002) |
|---|---|---|---|
| Target Population | General adult population across all settings | Specifically validated for the geriatric population | Varies by tool, some are more disease-specific |
| Screening Components | BMI, unintentional weight loss, acute disease effect | Questionnaire covering food intake, weight loss, mobility, stress, neuropsychological issues | Combination of nutritional and disease-related criteria |
| Key Focus | Broad screening for malnutrition and obesity risk | Comprehensive screening for malnutrition risk in the elderly | Focus can vary, sometimes on risk within a specific clinical context |
| Ease of Use | Quick and simple, requiring basic measurements and information | More detailed questionnaire, can be more time-consuming | Can be more complex, depending on the tool |
| HSE Endorsement | Yes, widely adopted across Irish healthcare settings | Used by the HSE for specific populations, particularly the elderly | Less commonly used for standard, system-wide screening within the HSE |
Conclusion: Proactive Care Through Effective Screening
The MUST assessment tool is a vital part of the HSE's approach to proactive nutritional care, ensuring that malnutrition and its associated risks are identified early and managed effectively. By providing a standardized, easy-to-use method for screening all adult patients, it empowers healthcare professionals to make informed decisions about diet and care plans, ultimately improving patient safety and outcomes. As a fundamental tool in the fight against malnutrition, understanding what is the must assessment tool HSE? is essential for anyone involved in modern healthcare delivery.
For more detailed information on the MUST tool, including explanatory booklets and resources, you can visit the BAPEN website(https://www.bapen.org.uk/).
