Nutritional Screening Tools
Poor nutritional status has a negative impact on health outcomes, increasing patient morbidity, mortality and increasing length of stay in hospital.
Malnourished patients are more likely to develop pressure ulcers and infections and have a slower recovery rate compared with well-nourished patients.
Evidence based guidelines for Nutrition Support in Adults recommend:
• Screening for malnutrition or the risk of malnutrition should be carried out by healthcare professionals with appropriate skills and training
• All hospital patients should be screened on admission.
Nutrition support should be considered in people who are malnourished, as defined by any of the following:
• A body mass index (BMI) of < 18.5 kg/m2
• Unintentional weight loss of >10% within the last 3-6 months
• BMI of < 20 kg/m2 and unintentional weight loss > 5% within the last 3-6 months.
Nutritional support should be considered in people at risk of malnutrition who have:
• Eaten little or nothing for 5 days and/or likely to eat little or nothing for the next 5 days or longer
• Poor absorptive capacity, and/or have high nutrient losses and/or have increased nutritional needs from causes such as catabolism.
A recent scholarly paper in the Australian Journal of Advanced Care Nursing suggests that nurses should become skilled and expert in rapid nutrition risk screening of patients, using one of the following screening tools:
Malnutrition Screening Tool (MST)
o Targets adult hospital patients
• Weight and Appetite
Malnutrition Universal Screening Tool (MUST)
o For all adults including those living in the community
• BMI, Weight and Acute disease
Mini Nutritional Assessment (MNA)
o Targets older adults across six clinical parameters including;
• Food intake decline and neuropsychological state.
In the absence of screening, nurses should record:
• Weight and height of patients on admission
• Any factors that impede nutrition‐ such as chewing or swallowing difficulties, physical incapacity or lower cognitive function.
Potential swallowing problems, dysphagia and functional feeding problems should be taken into account and the multidisciplinary team - including a dietitian and occupational therapist – should be engaged where a patient is at risk of malnutrition.
Patients who have difficulties self-feeding due to neurological conditions, muscle weakness, arthritis or other functional incapacity may require modified feeding aids during their admission and following discharge. Devices such as modified feeding plates and cutlery help to support activities of daily living and maintain patient independence in hospital and in the community.
Useful URL
NICE Clinical Guideline 32: Nutrition Support in Adults
www.nice.org.uk