Using the ‘MUST’

1. We would like to modify ‘MUST’ and incorporate it into our Trust documentation. To what extent can we change ‘MUST’?

  • The core elements of ‘MUST’ should be retained and BAPEN /MAG acknowledged if ‘MUST’ is to be modified and incorporated into local documentation
  • The tool should always be described as a nutrition screening tool and not an assessment tool
  • The cut-off points and scores must not be changed
  • If it is to be used in an acute hospital, all 3 steps should be included, but if it is to be used in other care settings then Step 3 (acute disease effect) may be omitted
  • At least 1 alternative measurement should be included in order to calculate a height if this cannot be measured or obtained by recall. MAG would suggest ulna length
  • Ideally ‘MUST’ BMI chart and weight loss tables should be available
  • Local management guidelines can be inserted or referred to in Step 5.

2. What if a patient scores between 2 and 6?
There is currently insufficient information to make confident judgements on the severity of malnutrition in subjects with ‘MUST’ scores between 2 and 6. Guidance on how best to manage these patients should be obtained by undertaking a more detailed nutritional assessment in line with local policy.

3. Has the care plan given in ‘MUST’ been validated too?
The recommendations given in the care plan in “The ‘MUST’ Explanatory Booklet” are guidelines based on best practice and currently available evidence for the benefits of nutritional intervention. The guidelines can be replaced by your local guidelines / care plan.

4. Why doesn’t the care plan in the ‘MUST’ Explanatory Booklet recommend the use of food fortification?
Potentially food fortification could be of value but there is little evidence that such modification to the diet (especially fortification with single or multiple sources of macronutrients) translates to improved clinical outcome or function.

5. How accurate are the alternative measurements suggested in ‘MUST’?
It is always better to obtain an actual height or ask the subject how tall they are rather than use an alternative measurement to calculate a height. It should be possible to do this in the majority of subjects. However, if height cannot be obtained, use of any of the alternative measurements, whilst not resulting in an exact height, will provide a calculated height that is sufficiently close to the actual height to place the majority of subjects in the correct BMI band and result in a correct overall category of malnutrition risk. Ulna length is generally found to be the easiest and quickest alternative measurement to use.

6. Do I need copyright permission to reproduce ‘MUST’?

  • The ‘MUST’ is freely available to use for non-commercial purposes.
  • If you wish to adapt the ‘MUST’ in any way, by adding an NHS Trust logo for example, or changing the management guidelines, copyright permission must be sought, and a copy of the adapted version sent to the BAPEN Office. ‘MUST’ artwork can be supplied for printing purposes.
  • If ‘MUST’ is to be used for commercial purposes, copyright permission must be sought and a licence agreement signed & a licence fee paid before original artwork is provided by BAPEN. File copies of the materials produced must be sent back to the BAPEN Office.
  • If ‘MUST’ is to be incorporated into materials for which BAPEN endorsement is sought, then a written proposal together with a draft of the materials to be produced must be submitted to the BAPEN Office. Two months should be allowed for this process and a fee will be charged. A copy of the BAPEN logo and a statement of endorsement will be provided for inclusion in the materials. Final copies must be sent to the BAPEN Office.
  • In every instance where ‘MUST’ is utilised (in print or on-line) the following wording must also appear:
  • “The ‘Malnutrition Universal Screening Tool’ (‘MUST’) is reproduced here with the kind permission of BAPEN (British Association for Parenteral and Enteral Nutrition)”. An indication must be made somewhere on the documentation that for further information on ‘MUST’ see www.bapen.org.uk.

7. How much does the ‘MUST’ cost?
Copies of PDFs of the ‘MUST’ tool and “The ‘MUST’ Explanatory Booklet” can be downloaded free of charge from the BAPEN website: www.bapen.org.uk.

Additionally, printed copies of the ‘MUST’ tool (A5 and A4 sizes), “The ‘MUST’ Explanatory Booklet” and “The ‘MUST’ Report” can be purchased from the BAPEN office. For further information and prices contact:

BAPEN Office
Seven Elms,
Dark Lane,
Astwood Bank,
Redditch,
Worcestershire,
B96 6HB
Tel: 01527 457850
E-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.

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