Increased frequency and accuracy of MUST screening after use of a nutrition screening round

Abstract

Background: Surveys indicate that malnutrition remains common among hospital patients (Russell & Elia, 2010). It is recommended that all patients be screened on admission and weekly (NICE, 2006). The Malnutrition Universal Screening tool (MUST) is a sensitive and specific screening measure (Kyle et al., 2006). In Homerton Hospital, the nutrition screening round (NSR) ran alongside transition of paper-based screening onto an electronic patient record system (EPR). This study aimed to assess the effectiveness of a dietitian-led NSR as a method of training staff to use MUST. Methods: Malnutrition screening was audited on an elderly care ward and an adult rehabilitation unit. The number of MUST scores undertaken within 24 h of admission and the frequency of weekly screening were assessed. Data gathered included the numbers of patients with accurately measured height, weight, body mass index, weight loss and acute disease effect scores. A weekly NSR was then conducted on these two wards alongside consultant ward rounds, with the dietitian carrying out nutritional care and all staff gaining practical experience of MUST by assisting with screening of each patient. After 20 weeks, screening levels were re-audited and, at 24 weeks nursing staff took back full responsibility for MUST screening. A final audit of screening levels took place 1 month after staff on the two designated wards had taken back responsibility for screening. Results: The initial audit indicated that, of 53 patients, 26 had a paper MUST proforma present. Of 23 patients who were on the wards for >7 days who had a MUST proforma, only one was screened each week as per NICE guidelines. The 20-week mid-intervention audit showed that the number of patients on the wards for ≥1 week with an accurate MUST screen recorded on EPR had increased to 100%. Increased detection of malnutrition led to prompt, effective nutrition support. The final audit at 28 weeks showed sustained screening levels, with all patients on the ward for ≥1 week being accurately screened for malnutrition by ward staff alone. Discussion: The NSR appeared to target factors identified as being behind low levels of screening, including a low awareness of screening policy and poor screening skills (Porter, et al., 2009).Confidence in carrying out MUST was increased by ‘hands-on’ training in the immediate patient environment. Perceived barriers to screening cited in other research include pressures of workload (Hodge, 2008). The NSR demonstrated that screening was not as time consuming as assumed and that it could be fitted alongside other tasks. Previous studies have suggested training might be targeted toward all clinical staff (Wong & Gandy, 2008). The NSR project supports this finding, demonstrating that the involvement of all members of the multiprofessional team is strongly conducive to embedding MUST within clinical care and as part of weekly ward routine. Conclusions: A NSR is an effective way of providing practical training in nutritional screening. A NSR raises the ward level profile of screening, encourages it to become routine practice and is a feasible method of increasing frequency of screening in line with policy to enhance patient care.