Nutritional screening of elderly patients: a health improvement approach to practice

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Almost 60% of elderly care in-patients are at risk of malnutrition. Malnourished patients have poorer clinical outcomes and this is a key factor with respect to prolonging the length of stay. Since 2003, the Malnutrition Universal Screening Tool (MUST) has been advocated as a method for identifying these at-risk patients. Screening should take place on admission; however, the Trust has set a stretch target of aiming to document the score accurately within 6h of admission. Three 'care of the elderly' wards participated in the project. Each month, the timeliness (within 6h of admission) and accuracy (compared to a dietician assessment) of the MUST scores on the wards were reviewed. Plan-Do-Study-Act cycles were used to rapidly test changes in the ward areas. Tests included a study day, one-to-one ward-based nutrition training, a focus on the use of alternative anthropometric measurements, the development of a training pack and the identification of the challenges for undertaking accurate and timely assessments. Baseline data identified that a MUST was documented in <60% of patients within 6h of admission and that only 70% were accurate. After implementation of the change package, all the wards achieved an improvement and documented MUST within 6h of admission; one ward achieved 90% accuracy in the scores. Ward teams receiving training and monthly feedback of their results creates ownership, momentum and maintains enthusiasm for striving to reach stretch targets. The team continues to work on improving accurate nutritional screening across the Trust by using quality improvement methodologies.