Malnutrition Universal Screening Tool (MUST)
MUST is a five-step screening tool aimed at identifying adults who are malnourished, at risk of malnutrition (undernutrition), or obese. It provides management guidelines to help develop a care plan, useful in hospitals, communities, and other care settings.
Key Components
- Flow chart: Details the 5 steps for screening and management.
- BMI chart: Used for calculating BMI scores.
- Weight loss tables: To assess unplanned weight loss.
- Alternative measurements: For cases where BMI cannot be obtained via standard methods.
- Explanatory Booklet: Offers additional guidance and training information.
Limitations
- Not applicable for detecting deficiencies or excess intakes of vitamins and minerals.
- Designed for use in adults only.
The 5 MUST Steps
- Measure height and weight to calculate BMI score using the provided chart.
- If unable to measure, use alternative procedures.
- Note percentage unplanned weight loss and score it using provided tables.
- Establish acute disease effect and score accordingly.
- Calculate overall risk by adding scores from steps 1, 2, and 3.
- Develop care plan using management guidelines or local policy.
Risk Categories and Management
- Low Risk: Score 0
- Medium Risk: Score 1
- High Risk: Score 2 or more
Guidelines
- Observe: Document dietary intake and repeat screenings at specified intervals.
- Treat: Refer to a dietitian or nutritional support, set goals, and monitor nutritional intake.
- Re-assess: Particularly important as patients transition through different care settings.
Special Considerations
- Obesity: Record obesity presence and manage underlying conditions before obesity treatment.
- Alternative Measurements: Use ulna length or mid upper arm circumference (MUAC) for height and BMI estimation.
Alternative Measurements Details
- Ulna length: Used to estimate height.
- MUAC: Provides a general indication of BMI.
Supporting Information
- MUST Explanatory Booklet: Available for detailed guidelines and alternative measurement methods.
- MUST Report: Contains evidence supporting the tool.
Additional Notes
- Supported by the British Dietetic Association, Royal College of Nursing, and Registered Nursing Home Association.
- First published by the Malnutrition Advisory Group (MAG) in 2003 and reviewed in subsequent years.