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.

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.

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!

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.

   
   

Step 2: % Weight loss

Step 3: Acute Disease Effect

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.

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.

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).

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

Outcome the Nutrition Care Plan per shift.