MALNUTRITION UNIVERSAL
SCREENING TOOL ‘MUST’
Nutrition screening tool should be completed on
admission and then weekly.
Patient’s Name:
Date of birth:
Date of admission: Height (m):
NHS Number:
Normal Weight (kg) (Reported): estimate / actual (please circle)
BMI : For each section below circle one score
Date
Signature
Actual
Actual
Actual
Actual
Weight (kg) Actual
kg kg kg kg kg
Weekly BMI
Body mass index (BMI) kg/m2 - calculate from chart over page
• 20 or more
• 18.5 - 20
• less than 18.5
If unable to obtain height and weight see `MUST` Explanatory booklet
for alternative measurement and use subjective criteria
Unplanned weight loss in the last 3-6 months - calculate from
tables over page
• <5%
• 5-10%
• >10%
Medical condition
• If patient is acutely ill and there has been or is likely to be no nutritional intake for >5 days score 2
0
1
2
0
1
2
0
1
2
0
1
2
0
1
2
0
1
2
0
1
2
0
1
2
2
2
2
2
2
0
1
2
0
1
2
Any patients commenced on NG/PEG/RIG/TPN – Refer to Dietitian
Totals
0 = Low risk
Routine Clinical Care
• Ensure adequate fluid intake
• Offer advice on food and drink choices
• Offer help and advice with feeding if needed
• Use appropriate feeding aids if required
• Help with positioning, sit out / up for meals
• Weigh weekly, recalculate %
weight loss over the last 3 – 6 months and rescreen weekly
• Document action taken in nursing notes
Action
1 = Medium risk
Observe
Complete food and fluid chart for 3
days. If improved or adequate intake:
• Little clinical concern, discontinue food intake chart
• Weigh weekly and repeat screen.
If inadequate intake or no improvement:
• Encourage and assist to eat and drink
• Continue accurate food and fluid intake chart daily
• If patient’s managing less than ½ meals, offer non-prescribable supplement drinks † (Complan /
Build up) at least twice daily
• Weigh weekly, recalculate % weight loss over the last 3 – 6 months and rescreen weekly
• Document action plan
• Liaise with catering if patient dislikes hospital food
2 or more = High risk
Treat
• Follow action plan for medium risk
• Refer to dietitian*
• Weigh twice weekly, recalculate % weight loss over the last 3 – 6 months and monitor
• Document action taken in nursing notes
*Unless detrimental or no benefit is
expected from nutritional support for
example end of life care pathway.
Referral to Dietitian (tick)
Date
Signature
This is a tool to assist your assessment. If in doubt use your professional judgement.
† BAPEN does not necessarily support the use of any products in particular.
100
99
98
97
96
95
94
93
92
91
90
89
88
87
86
85
84
83
82
81
80
79
78
77
76
75
74
73
72
71
70
69
68
67
66
65
64
63
62
61
60
59
58
57
56
55
54
53
52
51
50
49
48
47
46
45
44
43
42
41
40
39
38
37
36
35
34
6’3
Height (m)
1.48 1.50 1.52 1.54 1.56 1.58 1.60 1.62 1.64 1.66 1.68 1.70 1.72 1.74 1.76 1.78 1.80 1.82 1.84 1.86 1.88 1.90
5’7 5’71/2 5’81/2 5’91/2 5’10 5’115’111/2 6’01/2 6’1 6’2
Height (feet and inches)
4’101/24’11 5’0 5’01/2 5’11/2 5’2 5’3 5’4 5’41/2 5’51/2 5’6
55
56
57
15 10
15 8
15 6
15 4
15 2
15 0
14 11
14 9
14 7
14 5
14 2
14 0
13 12
13 10
13 8
13 6
13 3
13 1
12 13
12 11
12 8
12 6
12 4
12 1
11 11
11 9
11 7
11 4
11 3
11 0
10 11
10 10
10 7
10 6
10 3
10 1
9 13
9 10
98
96
94
91
90
8 11
88
87
84
83
80
7 13
7 10
77
76
73
71
6 13
6 11
68
66
64
61
60
5 11
59
Step 2 – Weight loss score
Weight before weight loss (st lb)
Note : The black lines denote the exact cut off points (30, 20 and 18.5 kg/m2), figures on the chart have been rounded to the nearest whole number.
The Malnutrition Universal Screening Tool ‘MUST’ is reproduced here with the kind permission of BAPEN (British Association for Parenteral and Enteral Nutrition).
Further information on the ‘MUST’ materials is available on the BAPEN website www.bapen.org.uk
Weight (kg)
Step 2 – Weight loss score
Weight before weight loss (kg)
Step 1 – BMI score (& BMI)
Weight (stones and pounds)