The Malnutrition Universal Screening Tool (MUST)
The Malnutrition Universal Screening Tool, or MUST, is a widely used and validated five-step process designed to help healthcare professionals identify, treat, and prevent malnutrition. Developed by the British Association for Parenteral and Enteral Nutrition (BAPEN), it is a cornerstone of nutritional care, endorsed by organizations like the National Institute for Health and Care Excellence (NICE). The tool is applicable in a range of settings, from hospitals and care homes to community care, ensuring a consistent approach to nutritional screening for all adults.
Malnutrition, also known as undernutrition, can have a significant and negative impact on patient outcomes, increasing complication rates, extending hospital stays, and affecting recovery. By providing a structured and reliable method for screening, the MUST tool allows for early detection and intervention. However, it's essential to remember that MUST is a screening tool and should always be used alongside clinical judgment.
The Five Steps of the MUST Tool
The MUST process is straightforward and can be carried out by any trained care worker. It involves a clear, five-step flow to reach a risk classification and inform a care plan.
- Measure BMI Score: The first step is to determine the individual's Body Mass Index (BMI). This is calculated using weight and height measurements. The tool provides a chart for easy scoring, where a BMI below 18.5 kg/m² scores 2, between 18.5 and 20 kg/m² scores 1, and above 20 kg/m² scores 0. A BMI over 30 kg/m² should be noted as obese. Alternative measurements, such as mid-upper arm circumference (MUAC), can be used if weight or height cannot be obtained.
- Note Weight Loss Score: The second step assesses the percentage of unplanned weight loss over the past 3 to 6 months. A loss of 5-10% scores 1, and a loss of over 10% scores 2. If weight loss is less than 5%, the score is 0. This information can be gathered from patient records or by asking the individual or their carers.
- Establish Acute Disease Effect Score: If the patient is acutely ill and has had, or is likely to have, little or no nutritional intake for more than 5 days, a score of 2 is assigned for acute disease effect. Otherwise, the score is 0.
- Add Scores to Obtain Overall Risk: The scores from the first three steps are added together to determine the overall risk of malnutrition. A total score of 0 indicates low risk, 1 indicates medium risk, and 2 or more indicates high risk.
- Use Management Guidelines: Based on the overall risk score, management guidelines are used to create an appropriate nutritional care plan.
Comparison of Nutritional Screening Tools
While MUST is a prominent tool, others exist for specific populations or settings. A comparison helps illustrate why MUST is so widely used in general adult care.
| Feature | Malnutrition Universal Screening Tool (MUST) | Nutritional Risk Screening 2002 (NRS-2002) | Mini Nutritional Assessment-Short Form (MNA-SF) |
|---|---|---|---|
| Target Population | General adult population across all care settings. | Hospitalized adults, especially with severe illness. | Elderly patients. |
| Key Parameters | BMI, unintentional weight loss, acute disease effect. | BMI, weight loss, reduced intake, disease severity, age. | Food intake issues, weight loss, mobility, acute disease, stress, BMI. |
| Assessment Style | Primarily objective measurements with subjective criteria if needed. | Combines nutritional status score with disease severity score. | Short, quick questionnaire. |
| Scoring | 0 (low), 1 (medium), ≥2 (high) risk. | ≥3 indicates at risk of malnutrition. | ≤11 indicates risk of malnutrition. |
| Strengths | Simple, quick, and valid across multiple settings. | Validated and recommended for hospitalized patients. | Quick and reliable for elderly patients. |
| Limitations | May overestimate risk in certain cases, not designed for vitamin/mineral assessment. | Can be more complex and time-consuming for general use. | Specific to older adults, not universally applicable. |
Management Based on MUST Scores
The final step of the MUST tool is perhaps the most important, as it directly informs the individual's care plan.
- Low Risk (Score 0): Patients in this category require routine clinical care and should be rescreened periodically. For hospital inpatients, this is weekly; for care home residents, monthly; and for community patients, annually.
- Medium Risk (Score 1): These individuals should have their dietary intake monitored for three days. If intake is adequate, they can return to routine screening with increased frequency. If intake is inadequate, specific interventions should be implemented, such as fortified diets or nutritional drinks, with the care plan monitored regularly.
- High Risk (Score ≥2): Immediate action is required for high-risk patients. They should be referred to a dietitian or nutritional support team for a comprehensive nutritional assessment and a specific care plan. Monitoring and reviewing the care plan must be done regularly to track progress.
- Obesity: The MUST tool also identifies obesity. For obese individuals with underlying conditions, these are addressed first, but the patient is still categorized for further nutritional management.
Conclusion
The MUST risk assessment tool is an invaluable asset in the field of nutritional health, offering a standardized, five-step approach to identify and manage malnutrition. By assessing BMI, weight loss, and acute illness, it effectively categorizes adults into risk groups, enabling timely and targeted interventions. The tool's wide applicability, ease of use, and integration with management guidelines have made it a standard in healthcare settings, leading to improved patient outcomes and more effective nutritional care. While other tools may be better suited for specific populations, MUST's universal design makes it the must risk assessment tool for general adult nutritional screening. For more information on the MUST tool, visit the BAPEN website.
Note: The Malnutrition Universal Screening Tool (MUST) provides a structured and evidence-based approach to nutritional risk assessment, which is fundamental to developing effective nutrition diets and care plans for individuals in need.
