Screening of patients using a validated method or tool is the first step in identifying people that are at risk of being or becoming, malnourished and who are likely to require nutrition intervention / support.
Whichever tool is used (see below), screening should be quick and easy to do so that it can be routinely done by appropriately trained staff accurately within a few minutes.
Once an individual is identified as ‘at risk’, a treatment pathway should determine the appropriate course of action – whether this involves help and advice with eating and drinking, supplementary nutrition or referral to a dietitian. There should be no delay in treating identified patients.
Nutrition Screening Tools
There are many nutrition screening tools in use but the most commonly used screening tool in Ireland is the ‘Malnutrition Universal Screening Tool’ (‘MUST’). This was developed and launched by BAPEN (UK) in 2003. It was designed to be valid, reliable and easy to use in all adults. It is not designed to detect deficiencies in or excessive intakes of vitamins and minerals. The MUST has been recommended for use in hospitals by the Department of Health.
Why use MUST
- Simple and easy to use
- Good predictive validity and good sensitivity/specificity vs clinical assessment by a dietitian
- Standard tool used in UK and main tool used in Ireland (allows comparison)
- Can be used in hospital and community
How to use MUST
The ‘MUST’ comprises a five-step process including:
- Body Mass Index (BMI)
- Recent unplanned weight loss
- Acute disease effect
From these, a score is generated to determine level of risk as follows:
- Low risk = 0,
- Medium risk = 1
- High risk = 2 or >2.
The score prompts users to take appropriate action and to develop a nutritional care plan based on management guidelines and/or local policy.
Other Validated Screening Tools
MNA (Mini Nutrition Assessment) Tool
A validated screening and assessment tool designed for patients aged 65 years and above which was developed by Professor Bruno Velas in association with the Nestle Nutrition Institute. A Short version of the tool has now been validated for use.
SNAQ (Short Nutritional Assessment Questionnaire)
This questionnaire was developed in the Netherlands and was validated as a quick screening tool for malnutrition risk in hospital inpatients. It consists of three questions which relate to recent unintentional weight loss, decreased appetite and the use of supplemental drinks or tube feeds. The SNAQ screening tool used in hospitals was derived from a longer assessment questionnaire and adapted SNAQ tools (screening tools and treatment plans) have been developed for use in older populations (SNAQ 65 – for community dwelling older adults and SNAQRC- for nursing home/residential care residents)