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When do you need to screen for malnutrition? 

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When do you need to screen for malnutrition? 

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Nutrition screening should be completed within 24 hours of admission, with any clinical change, transfer of care or at least weekly using either the Malnutrition Universal Screening Tool (MUST) or the Renal iNUT Screening Tool.

Access the ‘Adult Basic Admission Assessment’ through Care Compass. For repeat risk assessments this an be accessed via AdHoc using the ‘Adult Basic Admission Form’ or within ‘Obs and Assessments’ using the ‘Adult Risk Assessments’ Band.

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Nutrition Screening for MUST: First gather MEASUREMENTS: 

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Nutrition Screening for MUST: First gather MEASUREMENTS: 

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Gather your patients weight, height, recent unplanned weight loss history before completing the Power Form MUST.

Look up on Cerner / London Care Record, speak to the patient and carers for this information.

If you have your patients actual weight and height, BMI will be calculated for you on the MUST Powerform.

If you are unable to weigh or can't find this information on Cerner read on!

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The gold standard is to measure a patients height with a stadiometer.

The next best option is to ask the patient / relative for their height.

You can also use the patients ulna length to estimate height. Click play to learn how to measure ulna length. You will need a tape measure !

Add the ulna length in cm to the MUST Powerform and it will calculate estimated height for you.

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Now complete the MUST Tool with your actual or estimated measurements:  

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Now complete the MUST Tool with your actual or estimated measurements:  

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Step 1: BMI

Step 2: % Weight loss

Step 3: Acute Disease Effect

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If you are unable to weigh your patient

You have a 2 options:

1. Estimate weight (ask patient and family to help)

2. Estimate the patient BMI using the MUAC. You will also need to use your clinical judgement (see next slide).

You will need a tape measure.

The Mid- Upper- Arm- Circumference can estimate BMI range. Press play to learn how to measure MUAC. Add MUAC measurement in cm into the MUST Power form.

Estimate BMI from the table in the Tool:

If MUAC < 23.5 cm, BMI < 20 kg/m2

If MUAC is 23.5- 32cm, BMI is 20-30 kg/m2

If MUAC is > 32cm, BMI > 30 kg/m2

You can use this estimated or actual BMI to score STEP 1 of the MUST Tool.

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Use your MUAC score, together with your subjectivity to score BMI on MUST.

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You can often see weight loss visually: loose clothes, loose rings and muscle wasting. Very often you cant. Overweight patients can still be at risk of malnutrition from recent weight loss.

Speak to the patient, carers, check weight history on Cerner to get a weight or estimated weight 3-6 months ago.

If you add weight, and weight 3-6 m ago, the MUST Cerner tool will calculate % weight loss for you.

If you have no specific weight loss history, but just a vague sense from the patient / family you can estimate weight loss score. This should be a last resort.

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Is the patient acutely unwell and has been or likely to have no nutritional intake for > 5 days?

Select Yes or No.

Both need to be in place to select Yes.

Yes = 2 points on the MUST Tool, No = 0 points.

What is acute disease effect?

If the subject is currently affected by an acute patho-physiological or psychological condition, and there has been no nutritional intake or likelihood of no intake for more than 5 days, they are likely to be at nutritional risk. Such patients include those who are acutely ill, those who have swallowing difficulties (e.g. after stroke), or head injuries or are undergoing gastrointestinal surgery.

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Score 0- LOW RISK: Continue to repeat screening weekly for all patients regardless of score.

Score 1 - MEDIUM RISK: Smart Zone Alert in Care Compass will prompt you to complete a nursing Nutrition Care Plan.

Score 2 or more - HIGH RISK: Smart Zone Alert in Care Compass will prompt you to complete a nursing Nutrition Care Plan PLUS Refer to the Dietitian (via Orders).

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How to order and outcome Nutrition Care Plans 

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How to order and outcome Nutrition Care Plans 

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Click on Smart Zone Alert, or order the Nutrition Care Plan.

Accept Care Plan with green flag, select relevant from the list.

Outcome the Nutrition Care Plan per shift.

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Click onto this new padlet for information on renal screening.

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Refer all patient to Nutrition and Dietetics who require, or who are admitted, on enteral tube feeding, regardless of MUST score.

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More information on the MUST Tool can be found here.

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Take 10 min to test your knowledge on MUST screening.

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Have you found this padlet on malnutrition screening useful?