Implementing ‘MUST’

1. Why is nutritional screening necessary?
Early identification of patients who are nutritionally depleted (or likely to become so) is vital in order to provide timely and appropriate nutritional intervention. Nutritional screening should result in early identification of those patients who might have otherwise have been missed.

2. Who should I screen and when?
NICE recommend screening for malnutrition and risk of malnutrition across all healthcare settings. Patients should be screened:

  • on admission to hospital and weekly thereafter
  • at their initial out-patient appointment
  • on admission to care homes or where there is clinical concern
  • at initial registration at general practice surgeries, when there is clinical concern or at other opportunities e.g. health checks, flu injections.

3. We have our own nutrition screening tool, why should we change to using ‘MUST’?
If you already have a nutrition screening tool in use then there is no need to change to ‘MUST’ - especially if it is validated, reliable, easy and quick to use, and acceptable to patients and healthcare workers.

However, you may wish to review the evidence for the criteria used in your tool and perhaps think about comparing your tool with ‘MUST. If they identify the same subjects as being at risk of malnutrition then fine, but if not perhaps you should discuss changing to ‘MUST’ with your healthcare colleagues.

NICE suggest that nutritional screening should take into consideration body mass index (BMI), percentage unintentional weight loss and the time over which nutrient intake has been unintentionally reduced and/or the likelihood of future impaired nutrient intake. These parameters are the same as those in ‘MUST’ Steps 1-3.

4. How do I go about implementing nutritional screening?
Planning is fundamental to the successful implementation of nutritional screening in any healthcare setting. A number of steps should be considered e.g.

  • Identify and secure your stakeholders - what’s in it for them?
  • Set up a steering group
  • Identify any resources required e.g. weighing and measuring equipment
  • Agree actions and timelines
  • Agree care plan and management of those identified as at risk
  • Agree who will deliver the training and how will it be rolled out?
  • Consider how training will be delivered on an on-going basis?
  • Audit and review

5. What do I do once I have screened my patients?
The results of nutritional screening should always be linked to care plans and clear goals for nutritional intervention should be set and reviewed on an ongoing basis.

Step 5 of the ‘MUST’ provides guidance on the management of those patients identified as being at Low, Medium or High risk of malnutrition. This step can be adapted to fit with local nutrition guidelines or policies.

The results of screening should be communicated to members of the multidisciplinary team and across healthcare settings as the patient moves between primary and secondary care.

6. Are any training resources or materials available for me to use in the UK?
A number of the Medical Nutrition companies can support you with training and resources – contact your local representative for further information.

If you have any queries relating to the practical application of ‘MUST’ please contact Vera Todorovic (This email address is being protected from spambots. You need JavaScript enabled to view it.) or Christine Russell (This email address is being protected from spambots. You need JavaScript enabled to view it.).

For further information on any other aspect of the ‘MUST’ please contact the BAPEN Office. Printed copies of all ‘MUST’ materials are available to purchase from the BAPEN office:

BAPEN Office
Seven Elms,
Dark Lane,
Astwood Bank,
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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