Malnutrition Universal Screening Tool Score Research Articles

Prognostic value of serum 25-hydroxyvitamin D levels and malnutrition status on postoperative complications in patients following laryngectomy with neck dissection.

Postoperative complications (PCs) following total laryngectomy remain a significant challenge, with recent investigations directed toward the impact of nutrition status and vitamin D deficiency. To elucidate the association between preoperative vitamin D level status, malnutrition risk score, and surgical and survival outcomes in patients with advanced laryngeal cancer following total laryngectomy. Prospective cohort study. Sixty-four patients with advanced laryngeal carcinoma treated with total laryngectomy were included in the study. Serum levels of 25(OH) D3 were measured employing a commercial chemiluminescent immunoassay kit, while nutrition status was evaluated using the nutrition risk index (NRI) and Malnutrition universal screening tool (MUST). The mean serum 25(OH) D level was 37.1 ± 19.4 nmol/L (range 11.0-100.6 nmol/L), with 47% of patients exhibiting vitamin D deficiency and 31% displaying insufficiency. Medium/high MUST score had 53% of patients, and moderate/severe NRI was verified in 48% of patients. Univariate logistic regression analysis identified MUST score, GPS score, neutrophil-to-lymphocyte ratio, and circulating 25(OH) D levels as predictive for the occurrence of PCs. In multivariate analysis, MUST score and circulating 25(OH) D levels remained significantly associated with PCs. Patients with high nutrition risk had significantly lower two-year OS rates compared to the medium and low nutrition risk groups, respectively (30% vs. 62% and 83%, p = 0.010). Early identification of malnourished or patients with vitamin D deficiency and those who would benefit from specific nutritional support could be beneficial for minimizing the risk of development of surgical complications and help improve our clinical outcomes.

Documentation of anthropometrics in people with cancer: a cross-site collaboration audit in four hospital settings in the UK

BackgroundMalnutrition is a significant risk for patients during cancer treatment. Neglecting to monitor or provide timely dietetic support can result in lower tolerance to treatments and reduced quality of life. This audit aimed to assess the completeness and accuracy of the documentation of anthropometric measurements in medical records and dietetic referral practices across four day-treatment units (DTUs) in England.MethodologyData were collected from electronic patient records of 100 patients in each DTU attending for systemic anti-cancer treatment (SACT) over a 2-week period. Data collected included patients’ demographics, anthropometric data, referrals to dietitians, and whether the patients referred had a MUST score ≥ 2, which was calculated by the authors.ResultsFindings revealed that weights and heights were documented for 58–85% and 94–98% of patients attending DTUs, respectively. On average, 55% (range of 7–85%) of patients had their body mass index (BMI) documented on the day of SACT. The Malnutrition Universal Screening Tool (MUST) was rarely completed (≤ 3% in each centre). Dietetic referral practices varied across centres.ConclusionsFindings highlight the need to improve anthropometric documentation practices in cancer centres, in order to allow better monitoring of malnutrition risk and early nutritional support interventions when needed.

To evaluate dietary protein intake as per recommended dietary allowance (RDA 2020) and correlate it with the malnutrition universal screening tool score (must) in urban Indians aged 40-60 years.

To evaluate dietary protein intake as per recommended dietary allowance (RDA 2020) and correlate it with the malnutrition universal screening tool score (must) in urban Indians aged 40-60 years.

WP8.3 - "Effectiveness of Malnutrition Screen and Interventions for Surgical Inpatients - A MUST Score Based Audit"

Abstract Malnutrition significantly impacts surgical inpatients, affecting outcomes like infection rates, hospital stays, and wound healing. This audit evaluates the effectiveness of the Malnutrition Universal Screening Tool (MUST) in identifying at-risk surgical inpatients and examines the subsequent interventions and nutrition assessments. Our prospective audit encompassed surgical inpatients admitted for elective procedures or via the emergency department. Data were collected through patient records and medical charts, focusing on MUST score completion, accuracy, and updates. The audit assessed staff training, consistency in scoring, and the quality of nutrition interventions documented by dietitians. Key findings revealed a high completion rate (83.3%) of MUST scores but identified significant inaccuracies due to insufficient consideration of BMI, weight loss, and acute disease effect. Only a minor percentage (15.6%) of patients had their MUST scores updated. Staff training inadequacies and inconsistent scoring practices were noted. Despite these limitations, clinical teams effectively identified at-risk patients using their judgment and promptly initiated interventions. A malnutrition awareness week was organised with the dieticians, and teaching sessions were conducted for the healthcare staff to enhance understanding and application of the MUST tool. This initiative aimed to raise awareness and improve the quality of malnutrition screening and management. The audit highlights the need for improved accuracy in MUST scoring, enhanced staff training, and ongoing professional development. Recommendations include comprehensive staff training, standardized documentation processes, interdisciplinary collaboration, and patient and family education. This audit underscores the importance of accurate malnutrition screening and effective interventions to improve patient care quality for surgical inpatients. It calls for action plans to address the identified gaps, thereby enhancing malnutrition management within healthcare settings.

Evaluating the Outcomes in Patients with Colorectal Cancer Using the Malnutrition Universal Screening Tool: A Systematic Review.

The current systematic review aimed to evaluate the Malnutrition Universal Screening Tool (MUST) for its effectiveness in determining patient outcomes (length of hospital stay, postoperative complications, infection rates, and survival) for colorectal cancer. Utilizing a comprehensive search strategy, this review mined literature up to December 2023 from the PubMed, Scopus, and Embase databases. The focus was on identifying studies that scrutinize the prognostic value of MUST in relation to hospital outcomes in colorectal cancer contexts. Adherence to PRISMA guidelines ensured a systematic approach, encompassing various study designs and outcome measures. Among the seven studies incorporating 1950 patients, a significant correlation emerged between MUST scores and key hospital outcomes. Specifically, patients categorized as high MUST risk faced longer hospital stays, with a mean length of stay for high-risk patients extending up to 26.6 days compared to 14 days for those at lower risk. The prevalence of postoperative complications was substantially higher in the high-risk group, with up to 41.4% of high MUST risk patients experiencing severe complications (Clavien-Dindo 3-5) compared to 8.5% in the low-risk category. Notably, the review found that high MUST scores were strongly predictive of increased postoperative complications and a prolonged hospital stay, underscoring the tool's critical predictive utility for quality of life and use in clinical settings. Therefore, MUST's capability to predict longer hospital stays and a higher incidence of postoperative complications among high-risk patients highlights its essential function in preoperative evaluations and supports the integration of MUST into routine clinical assessments.

Overall mortality for community-dwelling adults over 50years at risk of malnutrition.

It is well reported that malnutrition in acute care is associated with poorer health outcomes including increased mortality. However, the consequences of malnutrition on survival in community settings is uncertain. Malnutrition in people 65years or over is often cited. Nevertheless, this study includes both middle-aged and older adults as current public health policy is highlighting the need to increase disease-free life years and is moving away from just extending life to increase overall longevity. The aim of this study is to describe the association of the risk of malnutrition using the Malnutrition Universal Screening Tool (MUST) with mortality in community-dwelling middle-aged and older adults. We used the UK Biobank to investigate the association between those at risk of malnutrition and mortality in participants aged ≥50years. MUST identified risk of malnutrition and linked data to national death registries confirmed mortality. Years of life lost (YLL) and Cox proportional hazard models with hazard ratios (HR) and confidence intervals (CI) described risk associated with all-cause mortality. There were 502408 participants recruited, 117830 were ≤50years leaving 384578 eligible participants. Based on MUST scores 63495 (16.5%) were at risk of malnutrition with 401 missing some data and excluded. Incidence of mortality for at risk participants was 755 per 100000 person-years, corresponding to 153476 YLL. Of those at risk of malnutrition, 9.5% died versus 7.8% at low risk. Initial survival analysis reported an increased risk of mortality (HR 1.29, 95% CI: 1.25 to 1.33) that decreased after adjusting for confounders (HR 1.14, 95% CI: 1.11 to 1.18) in those at risk of malnutrition versus those at low risk. Risk of malnutrition was associated with increased overall mortality. Modest effect sizes are demonstrated but are supportive of public health policies, which advocate wide-scale community, based nutritional screening for middle-aged and older adults.

High prevalence of malnutrition in an internal medicine department: results from the AMIDO study

The prevalence of malnutrition in patients is very high in Europe (>70%). An Italian FADOI-SINPE survey revealed that malnutrition is an underestimated problem by internists. The AMIDO study examines malnutrition in Acqui Terme Hospital (Alessandria, Italy) Internal Medicine Department patients. Patients were screened for malnutrition using the Malnutrition Universal Screening Tool (MUST) upon admission. 268 patients (49.63% male) were enrolled, with a median age of 83 years. At admission, the prevalence of malnutrition risk was 48.88%. The proportion of patients who came from home resulted to have a slight decreasing trend among the three subgroups according to MUST (84.67%, 82.76%, and 73.53% in increasing order of MUST score respectively), but was not statistically significant (P=0.10). Dementia [odds ratio (OR): 6.36; 95% confidence interval (CI): 2.52-18.63], heart failure (OR: 2.45; 95% CI: 1.33-4.57), neoplasm (OR: 2.24; 95% CI: 1.08-4.77) and infectious diseases (OR: 2.27; 95% CI: 1.226-4.274) increase malnutrition odds. Increasing attention to malnutrition risk is crucial for patients with dementia, neoplasm, heart failure, and infectious diseases, which raise malnutrition risk probability.

Prevalence of Malnutrition and Influence of an Individualized Nutritional Support on the Nutritional Status of Cancer Patients

Background: Muscle mass loss, impaired dietary intake, and poor nutritional status are hallmarks of patients with cancer. Cancer-associated malnutrition can lead to several negative consequences, including poor prognosis, reduced survival, increased therapy toxicity, reduced tolerance and compliance to treatment, and diminished response to drugs. The main aim of this study is to understand the prevalence of malnutrition using Global Leadership Initiative on Malnutrition Criteria (GLIM Criteria) and evaluate the impact of tailor-made nutritional intervention on the nutritional status of patients with cancer. Methods and Material: An interventional prospective study was conducted among 100 adult hospitalized cancer patients. The study was based on the Nutrition Care Process model, where nutritional assessment was done using GLIM criteria and Malnutrition Universal Screening Tool (MUST), and muscle mass was assessed using the Handgrip Dynamometer. Nutritional diagnosis was made based on assessment; nutritional intervention was provided through Individualized Nutritional Counseling & Oral Nutritional Support, and nutritional monitoring was done for patients during their stay in hospital using 24-hour daily dietary recall. Nutritional evaluation was done at the time of discharge using GLIM criteria, MUST, and Handgrip Strength (HGS). Data analysis was done using SPSS v24 statistical software (developed by IBM) to find out the Mean and Standard Deviation. Paired t test, Chi-square test, and Regression Analysis were used to analyze the qualitative variables. Statistical significance was defined as P < 0.05. Results: The current study evaluated 100 participants among whom 26% of participants were malnourished as assessed by MUST and 22% participants had poor muscle strength. A paired t-test was performed and it was found that the calorie intake (1504.1 ± 158.7) and the protein intake (56.08±7.01) were almost double after the nutrition intervention. The difference was found to be highly statistically significant with P < 0.01. Thus, nutrition intervention significantly (P < 0.01) improved calorie and protein intake. The overall mean MUST score at baseline was 0.39 which was reduced significantly (P < 0.000) to 0.17 at the end of the study. The HGS improved significantly (P < 0.000) from 10.02 to 25.51 after the nutrition intervention and it was evidenced by 2.5 times increase in HGS (25.51 ± 2.40) by the end of the study. Conclusion: Individualized nutritional support with continuous monitoring and counseling resulted in improvement in nutritional status as evidenced through their improved MUST score and HGS.

Oral nutritional supplements in older outpatients with heart failure: rationale and design of the ALIMENT-HF trial.

The ALIMENT-HF trial aims to determine whether high-calorie and high-protein oral nutritional supplements (ONS) are safe and beneficial for older adult outpatients with heart failure (HF). This multicentre, single-arm, interventional pilot trial is designed to evaluate the tolerance, efficacy, and safety of ONS in older adult outpatients with chronic HF, malnutrition, and anorexia. In total, 80 outpatients with HF regardless of their left ventricular ejection fraction will be treated with ONS, including high-energy (900kcal/day) and high protein (36g/day) supplementation, at eight sites in Japan. Inclusion criteria are as follows: age, ≥65years; outpatients receiving maximally tolerated guideline-directed medical therapy for HF and without change in their diuretic dosage during the last 3months; outpatients at risk of malnutrition, defined as a Malnutrition Universal Screening Tool score ≥1 point, and anorexia, defined using a Simplified Nutritional Appetite Questionnaire for the Japanese Elderly (SNAQ-JE) score of ≤14 points. Nutritional intervention will continue for up to 120days, with an observational period lasting for a further 60days. The primary outcome is a change in body weight between baseline and day 120. The ALIMENT-HF trial will evaluate the tolerance, efficacy, and safety of high-calorie and high-protein-rich ONS in older outpatients with HF co-morbid with malnutrition and anorexia and will provide insightful information for future randomized controlled trials.

Effect of Diet Counseling on Nutritional Status of Chronic Respiratory Diseases Patients Enrolled in the Pulmonary Rehabilitation Program in a Teaching Hospital: A Pre-Post Intervention Study.

We conducted the study to assess the effect of patient-tailored diet counseling on the nutritional status of chronic respiratory disease (CRD) patients under the pulmonary rehabilitation program from June 2021-May 2022. These patients completed 2 months of patient-tailored diet counseling sessions under the pulmonary rehabilitation program, which consisted of 4-5 interactive diet counseling sessions fortnightly. The pre- and postassessment was done using standardized outcomes: Malnutrition Universal Screening Tool (MUST), body mass index (BMI), and ideal body weight. The study enrolled 110 CRD patients. There was a statistically significant improvement in pre- and postassessment in MUST score, appetite, and unintentional weight loss (P < 0.001). Most of the patient's BMI normalized. In prenutritional assessment, most of the patients were malnourished and in postassessment, the number of malnourished and anemic patients was reduced. This study concludes that nutritional counseling effectively improves nutritional status and anemia.

Prevalence of the use of oral nutritional supplements among acute inpatients at risk of malnutrition and associated patient characteristics.

To provide a snapshot of the current use of oral nutritional supplements, its association with inpatient characteristics, and with a focus on the role of nursing monitoring of food intake and implementing nutritional interventions for patients with low intake. Retrospective cohort study. The study collected data from a hospital database regarding oral nutritional supplement initiation and variables of patients hospitalised in internal medicine departments, who did not receive enteral or parenteral nutrition. Of the 5155 admissions, 1087 fulfilled the inclusion criteria (47% female; mean age, 72.4 ± 14.6 years; mean length of stay, 14.6 ± 11.4 days). Sufficient food intake reporting was noted in 74.6% of the patients; of these 17% had decreased intake. Oral nutritional supplements and non-oral nutritional supplements groups did not differ in terms of sex, age, length of stay, Charlson Comorbidity Index, proportion of nursing reports, and absence of intake monitoring. Oral nutritional supplements were initiated in 31.9% of patients with a Malnutrition Universal Screening Tool score ≥2 and in 34.6% with decreased food intake. On multivariable analysis, hypoalbuminemia (adjusted odds ratio, 3.70), decreased food intake (adjusted odds ratio, 3.38), Malnutrition Universal Screening Tool score ≥2 (adjusted odds ratio, 2.10), and age <70 years (adjusted odds ratio, 1.56) were significantly associated with oral nutritional supplements use. The prevalence of oral nutritional intervention was suboptimal in patients at risk of malnutrition during acute hospitalisation, although decreased food intake and Malnutrition Universal Screening Tool score ≥2 independently increased the probability of oral nutritional supplements initiation. Understanding the clinical practice and nursing impact of care management in relation to nutritional intervention can assist in reviewing and improving patient care. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE IMPACT (ADDRESSING): This study informs clinical management and influences nursing practice standards related to assessing, monitoring, and managing malnutrition risk. The study impacts the quality of care for patients at risk of malnutrition. We adhered to the STROBE Checklist for cohort studies. No Patient or Public Contribution.

1722 A Quality Improvement Project to improve MUST score and food chart completion on Frailty Wards

Abstract Introduction Nutrition is one of the cornerstones of healthy aging. As we age, there are many changes in our bodies including decreased appetite and poor dentition, that contribute to increasing malnutrition. The MUST (Malnutrition Universal Screening Tool) score is a quick and effective tool to assess this. In this project, we reviewed MUST score and food chart completion on the frailty wards at EDGH to attempt to improve the nutrition of elderly patients. Methods The charts of seventy-five patients were reviewed over a period of one month. Following this, a training program for all the nursing staff was put in place. Initial results were discussed and the importance of nutrition in the elderly was highlighted. The staff were shown how to fill in the MUST score and follow management guidelines. Also, a reminder was set up on Nervecentre (local electronic patient record) for all staff. Results Of the initial seventy-five patients: 1 – a MUST score was completed for only 64% on admission to the ward 2 – 41.3% of patients were eating 50% or less of their meals 3 – In only 27% the reasons why they were not eating were documented. In the second cycle, eighty patients were included, and the results were markedly improved. 1 – The percentage of MUST score completion on admission increased to 91.3% 2 – Management guidelines were followed in 92.5% of the cases 3 – 18.8% with a MUST score of two or more, were referred to dietitians at an early stage Conclusions Our quality improvement project significantly increased MUST score completion and prompted action at an early stage. The third cycle in our improvement project is to improve the documentation of patients' food charts and encourage staff to look for and document the reasons why patients are not eating.

Effectiveness of a Digital Decision Aid for Nutrition Support in Women with Gynaecological Cancer: A Comparative Study

This study aimed to examine the effects of an animated Patient Decision Aid (PtDA) about dietary choices on decisional conflict and decision regret. A prospective, observational, two-group comparative effectiveness study was conducted with patients (n = 90) from a southern Taiwan oncology inpatient unit. Data included the Malnutrition Universal Screening Tool (MUST), laboratory results, 16-item Decisional Conflict Scale (sf-DCS), and 5-item Decision Regret Scale (DRSc). Data were collected at admission (T0), after the first-cycle of chemotherapy but before discharge (T1), and after the six-cycle chemotherapy protocol (T2) (around 3 months). Group A received standardized nutrition education and a printed brochure, while Group B watched a 10-minute information video during a one-on-one inpatient consultation and engaged in a values clarification exercise between T0 and T1. The percentage of women with a MUST score ≧1 in Group A sharply increased over time, but not in Group B. Decision aid usage significantly increased patients’ hemoglobin and lymphocyte values over time (p < 0.05). The digital PtDA contributed to less decisional conflict and decision regret in at-risk patients and improved their nutritional well-being. Decision-aids help patients make healthcare decisions in line with their values, and are sustainable for use by busy clinicians.

What is the most pertinent definition of malnutrition in epithelial ovarian cancer to assess morbidity and mortality?

IntroductionMalnutrition is common in ovarian cancer and is a major cause of morbidity and mortality. We aimed to define the most pertinent way to assess malnutrition in patients with epithelial ovarian cancer (EOC) in order to study its impact on morbidity (intra and post-operative complications) and survival (OS, overall survival and RFS, recurrence-free survival). MethodsWe retrospectively included all patients with EOC from 2003 to 2020. Nutritional status was assessed using the weight loss at diagnosis (more or <5%), albuminemia, the Nutritional Risk Index (NRI), and the Malnutrition Universal Screening Tool (MUST). ResultsSix hundred and fifteen patients were included. Among them, 34% declared having lost >5% of their usual weight, 58% had an albuminemia <35 g/L, 86% presented an abnormal NRI and 29% an abnormal MUST score. After univariate analysis, weight loss>5% appeared to be significantly associated with RFS. An abnormal NRI or MUST score were significantly associated with a decrease in OS in univariate analysis. None of the markers of malnutrition studied were correlated with morbidity. ConclusionWe were not able to reach a consensus concerning the most accurate definition to define malnutrition and predict morbidity and mortality in EOC. However, this modifiable prognosis factor must be systematically assessed and managed accordingly.

Assessment for the risk of malnutrition and nutritional support in older emergency laparotomy patients: a clinical audit

Abstract Aims Patients undergoing urgent abdominal surgery should undergo an assessment of the risk of malnutrition upon admission using the Malnutrition Universal Screening Tool (MUST). This assessment should trigger a response when patients are categorised as high-risk. This clinical audit aimed to determine whether older patients included in the National Emergency Laparotomy Audit (NELA) were identified as being at risk of malnutrition and whether they received appropriate nutritional support to address deficiencies if they were classed as high-risk as per the recommendations of the NICE (2017) guidelines. Methods Patients entered into the NELA database at a single NHS trust who were over 65 or older between January 1, 2021, and December 31, 2022, were included. The patient records were reviewed for the MUST score upon admission, and the presence of nutritional supplementation prescriptions, or dietetic referrals following the identification of a high-risk MUST score of 2 or above. Results Out of the 300 older NELA patients included in this clinical audit, 98% had a recorded MUST score. Between them, 114 patients had a high-risk MUST score, but 35% of these high-risk patients did not undergo a dietetic review. Additionally, 24% of high-risk patients received neither oral nor parenteral supplementation. Conclusions High-risk MUST scores in older NELA patients are readily available to surgical teams within the electronic patient record but do not consistently lead to interventions addressing nutritional deficiencies and nutritional screening is not currently included in NELA.

Enhancing the nutritional care of older people by recording actual body weight: a quality improvement project.

Malnutrition can have significant negative effects on older people's health, as well as a cost burden for health and social care services. Accurate, reliable and regular measurement of a patient's weight is important for prompt identification and management of malnutrition. This article discusses a quality improvement project that was undertaken in an emergency assessment unit for patients aged over 74 years in Northern Ireland. The aim of the project was to improve completion of Malnutrition Universal Screening Tool (MUST) scores for patients attending the unit by nursing staff recording actual weight rather than recalled weight. A simple intervention of relocating weighing scales in the unit's triage bay resulted in an increase in completed MUST scores from 60% ( n =18) to 97% ( n =29) in the six months following the intervention. Feedback from members of the multidisciplinary team indicated that the intervention had a positive effect on the care they provided to patients and on their working relationships with colleagues.

231 An evaluation of the dietetic service in a Geriatric Assessment Unit—nutritional status and outcomes

Abstract Background In 2021 the Geriatric Assessment Unit (GAU) was established, a 0.5 WTE dietitian was appointed to the multidisciplinary team. The Comprehensive Older Age Assessment (COAA) developed by the MDT included two nutritional screening tools—Malnutrition Universal Screening Tool (MUST) and the SARC-F questionnaire for sarcopenia. A MUST score of ≥2 and a SARC-F score of ≥4 were automatic dietetic referrals, referrals were also sent if a clinical concern was identified by the MDT. The aim of this review is to investigate the dietetic referral rates, nutritional status and compile a summary clinical outcomes. Methods A review of the dietetic excel database for the GAU, 2021 and 2022 was completed. The review included statistics on: (1) Referral rate, (2) Total number of dietetic interventions and a breakdown of new versus review patients, (3) MUST and SARRC- F score, (4) Body Mass Index (BMI) &amp; weight status and (5) Review of the dietetic outcome following intervention e.g. follow up versus discharge rate and weight status at review appointments. Results The data for 2021 and 2022 were combined—77.5% of patients attending the GAU were referred to the dietitian, 80% of patients referred attended a one to one consultation. 55% of all dietetic interventions were for new patients and 45% review patients. Average BMI was 25.5 kg/m2 and 27.7 kg/m2 in 2021 and 2022 respectively. 13% had a MUST score of ≥2. 49.8% had a SCAR –F score ≥ 4. 41% of patients had reported or documented weight loss. 70% required dietetic review. At dietetic review 39.5% had desirable weight gain, 39.5% were weight stable, with only 16% having an undesirable weight loss. Conclusion The requirements and benefits of a dietetic service can be seen in the high referral rate, documented concerns of weight loss and percentage of patients with a SARC-F score ≥ 4, leading to patient specific dietetic intervention, with a stable or improved weight status at dietetic review.

255 Preliminary findings from a prospective cohort study of Ireland’s first community Fibreoptic Endoscopic Evaluation of Swallowing (cFEES) service

Abstract Background Dysphagia is a common and resource-demanding symptom of many conditions. Dysphagia prevalence increases with age and can affect quality of life, nutritional status, hydration and increase healthcare utilisation/cost. Instrumental swallowing assessment is essential for accurate diagnosis and treatment. FEES is a gold standard diagnostic tool carried out by speech and language therapists (SLTs), typically in the acute setting. The aim of this study is to profile participants who accessed Ireland’s first cFEES service by describing clinical and process outcomes. Methods Adult patients referred for cFEES were invited to participate. Demographic, clinical and process data were recorded at index visit. A structured phone interview was completed at six months. Descriptive analysis was completed. Results In total, 53 participants were included: 70% were aged &amp;gt;65 years, median age was 72. Diagnoses included progressive neurological conditions such as motor neuron disease, multiple sclerosis and others (23%), Parkinson’s Disease, including Parkinson’s Plus Syndromes (15%), stroke (13%), head and neck cancer (11%), dysphagia unknown aetiology (9%), other (9%), chronic obstructive pulmonary disease (8%), other cancers (6%), and gastro-oesophageal reflux disease (4%). Nutritional status was screened using the Malnutrition Universal Screening Tool (MUST) at index visit for 44 participants. Of those, 23% (N = 10) had a MUST score ≥ 1. Dysphagia Outcome Severity Scale was used to rate swallowing: 43% had some degree of dysphagia (mild to severe). FEES referrals originated mainly from primary care SLTs: 75%, the remaining 25% from older person’s services (community nursing facilities, inpatient rehabilitation and integrated care for older persons). One participant was unable to tolerate the procedure, which was abandoned. Three participants experienced non-limiting gagging or hypersensitivity. Conclusion cFEES is a novel service model which was accessed mainly by older people. cFEES was tolerated well by most, leading to evidence-based outcomes including ruling out significant dysphagia in 57% of cases.

ThTP5.10 A clinical audit of assessment of the risk of malnutrition and the subsequent nutritional support prescribed for older emergency laparotomy patients

Abstract Aims Patients should have assessment of the risk for malnutrition on admission using a Malnutrition Universal Screening Tool (MUST) and this should trigger a response if patients are categorised as high risk (National Institute for Health Care and Excellence, 2017). This clinical audit sought to identify if older patients undergoing emergency laparotomy were identified as at risk of malnutrition with subsequent interventions to address protein and energy deficiencies. Methods Patients entered onto the National Emergency Laparotomy Audit (NELA) database who were over 65 years of age during 1/1/21 to 31/12/22 were included. The patient records were screened for the MUST score on admission and whether nutritional supplementation was prescribed, or dietetic referral made, following the recording of a high-risk MUST score. Results Three hundred patients were included in the audit with 99.3% of the patients having a MUST score recorded on admission. One hundred and fourteen patients recorded a high MUST score, with 35% of the high MUST patients not receiving a dietetic review and 24% receiving neither oral nor parenteral supplementation. Mortality at 30 days was 13.9%. The wide variety of supplementation prescribed was changed to a protein and energy-based supplement upon dietetic review. Conclusions MUST scores are available to surgical teams, but high-risk scores do not always trigger an intervention to address deficiencies in older NELA patients. A protocol to ensure consistent approaches to supplementation before dietetic review would reduce variation and education of prescribers is needed to address the importance of prescribing protein-based supplements is needed.

ThTP5.12 Assessment of malnutrition and nutritional interventions in patients presenting with acute small bowel obstruction – are we ‘getting it right first time’?

Abstract Aims High levels of morbidity and mortality are associated with small bowel obstruction (SBO), a common general surgical emergency. Assessment of malnutrition and introduction of early nutritional interventions are of paramount importance in the management algorithm of these patients. We audited our practice of managing acute small bowel obstruction at a busy district general hospital comparing our practice against National Audit of Small Bowel Obstruction (NASBO) recommendations. Methods Data were gathered for all patients presenting with bowel obstruction to our Trust between 01/08/2022 and 30/11/2022. In depth review of patient case records was undertaken using electronic patient record systems (e-Track and Evolve). Results 195 patients were admitted with acute bowel obstruction. 68 patients (35%) had acute SBO (M: F; 34:34). 58 (85%) had no documentation of duration for which they had been ‘nil by mouth’ (NBM) prior to hospitalisation. Malnutrition universal screening tool score (MUST score) was completed in 29 (43%) patients. 59% of patients had an emergency computed tomography (CT) which confirmed diagnosis of SBO. 60% of patients were managed non-operatively. On an average, patients were kept ‘NBM’ for two days (range; 1-16 days). Average waiting time for peripherally inserted central catheter (PICC) was 9.6 days. Conclusions Evaluating our practice of managing patients with acute SBO has highlighted multiple areas for improvement to ‘get it right first time’. We have included stakeholders; nursing staff, dieticians, surgeons, junior doctors and vascular access team to implement action plan to optimise management in this cohort of patients in line with NASBO guidelines.