Nutritional Screening (MUST) Questions

Malnutrition is common in hospital and easy to miss, and it makes almost everything else worse: slower healing, more infection, longer stays. MUST, the Malnutrition Universal Screening Tool, is the standard way to catch it, and the CBT tests whether you can use it and act on it.

The five steps

MUST works through five steps, but it scores three things:

• BMI, scored 0, 1 or 2 as it falls.
• Unplanned weight loss over the last three to six months, scored by percentage.
• The acute disease effect: whether the person is acutely ill and has had little or no intake for more than five days.

The three scores are added to give an overall figure, which places the patient in a risk category with a matched plan.

The categories

The totals map onto three levels. A score of 0 is low risk: routine care and repeat screening. A score of 1 is medium risk: observe, keep a food record, and watch. A score of 2 or more is high risk: refer, usually to a dietitian, put a nutrition care plan in place, and monitor. Knowing which total means what is the core of most MUST questions.

MUST score	Risk	Action
0	Low	Routine care, repeat screening
1	Medium	Observe, food record, monitor intake
2 or more	High	Refer (usually to a dietitian), nutrition care plan, monitor

A normal BMI is not reassurance

One trap worth understanding. A patient can have a normal BMI and still be at real risk, because the acute disease component captures someone who has simply stopped eating. Six days with no intake scores regardless of how their BMI looks. Malnutrition risk is about trajectory as much as current size.

The score must do something

The most important point, and a common exam theme, is that a score is only useful if it changes care. A MUST score that sits in the notes with nothing done leaves the patient exactly where they were. Each category has an action, and nurses can and should carry it out. Screening is also repeated at set intervals, often weekly for inpatients, because risk moves as illness and intake change. Next: hydration and dehydration assessment. Five MUST scenarios first.