An evaluation of the adapted Malnutrition Universal Screening Tool (MUST) currently employed within hospice care setting at Dorothy House Hospice in Wiltshire

Abstract

In October 2012 an adapted version of MUST was introduced in Dorothy House Hospice to identify and support Palliative care patients with nutritional advice and appropriate care plans (Nutrition and Hydration Policy, 2013). This project aimed to evaluate MUST in a hospice setting and address the current lack of evaluation regarding the use of the Malnutrition Universal Screening Tool (MUST) within a hospice environment (Help the Hospices, 2009). In addition it also captured and explored the concerns voiced by the registered nurses who use the MUST in everyday practice. The ethics around this project was considered by The Clinical Governance Committee and the approval was obtained. Questionnaires were sent to all nurses in the hospice who use MUST. Open and close questions were used in this survey in order to explore nurses’ views regarding value of the MUST. Questionnaires were distributed to 47 nurses, 30 (64%) were returned. Semi structured interviews clarified unclear responses. 63% of all respondents felt that the MUST was not useful in the hospice environment. Moreover 53% indicated that MUST was not appropriate for palliative care patients. Whereas 27% respondents stated that MUST is useful and 23% nurses were happy to use it in their practice. Research in hospitals suggests a reluctance to use MUST due to negative impacts on oncological patients (Hopkinson and Corner, 2006). Moreover Green and Watson (2005) observed that nutritional screening tools require more work around validity and reliability in order to ensure suitability and accuracy. Furthermore (Savage & Scott, 2005; Raja et al., 2008) pointed out that the nurses clinical judgment is more accurate and sensitive in assessing patients nutritional status than using a screening tool. This case study is limited due to small sample and local use only. However the data shows that future study should be undertaken in order to explore and identify sensitive and accurate nutrition screening tool for palliative care patients. Also nurses who are using the MUST in their practice should be empowered to use their clinical judgement before using a screening tool. References; Green, S. M. and Watson, R. (2005) Nutritional screening and assessment tools for use by nurses: literature review. Journal of Advanced Nursing. Vol 50(1): 69-83 Help the Hospices. Food and Nutrition Group (2009) Professional consensus statement of nutritional care in palliative care patients. Available at: http://www.helpthehospices.org.uk/our-service/running-your-hospice/food-and-nutrition/consensusstatement/Accessed 21/3/13. Hopkinson, J. & Corner, J. (2006) Helping patients with advance cancer live with concerns about eating: a challenge for palliative care professionals. Journal of Pain and Symptom Management. Vol.31.pp 293-305. Nutrition and Hydration Policy (2013). Dorothy House Hospice Care. Not published – copy available on request. Savage, J. & Scott, C.(2005) Patient’s Nutritional Care in Hospital: an Ethnographic Study of Nurse’s Role and Patient’s Experience. London: RCN Institute Notes