How to calculate MUST scores

Malnutrition is a condition that can affect us all and happens when someone’s diet doesn’t contain the right amount of nutrients (undernutrition) or has too many nutrients (overnutrition). In a 2011 NICE study, it was found that malnutrition affects 41% of clients in residential care homes.

Signs of malnutrition

Some common signs and symptoms are:

• Feeling cold
• Feeling tired a lot of the time
• Feeling weak
• Getting ill
• Lack of energy
• Lack of interest in food and drink
• Long recovery times after being ill or having wounds
• Poor concentration
• Reduced appetite.

"Malnutrition affects 41% of clients in residential care homes (NICE, 2011)."

Screening for malnutrition

One way to monitor malnutrition is to screen people and define their nutritional status on a regular basis using the Malnutrition Universal Screening Tool (MUST), used across the NHS and throughout social care services.

5 steps to the MUST

For each of the below steps, refer to this handy guide provided by BAPEN, a charitable association aimed at raising awareness and advancing the care of people at risk of malnutrition.

Step 1

Measure a person’s height and weight to get their BMI score. If you’re unable to obtain someone’s height or weight then you should use a recently documented/self-reported height and weight – this is usually pretty reliable and realistic.

Step 2

Note the percentage of unplanned weight loss and score.

Step 3

Establish if there are any acute diseases or illnesses that may contribute to nutritional intake being poor and score this.

Step 4

Add each of the scores from steps 1, 2 and 3 together to obtain an overall risk of malnutrition.

Step 5

Use management guidelines and/or local policy to develop a care plan.

Low risk

Repeat the screening on a monthly basis in care homes and annually in the community.

Medium risk

• Keep records and document dietary intake for 3 days.
• If the dietary intake is adequate, repeat the screening monthly in care homes and every 2-3 months in community-based settings.
• If the dietary intake is poor, plans should be put into place to increase diet intake, care plans should be updated, key professionals should be made aware and the person should be more closely monitored.

High risk

The person should be referred to a dietician, plans should be put into place to improve their overall intake and the person should be closely monitored.

Topps’ tips for overcoming malnutrition

There you have it, a whistlestop tour to calculate MUST scores.

I’ll leave you with these final bits of advice:

• Follow any guidance given by doctors and dieticians
• Report any concerns
• Ensure the person has a balanced diet and follows their dietary plan
• Introduce smaller, regular meals
• Avoid processed foods
• Choose nutritious foods the person enjoys eating
• Keep the person active
• Snack between meals
• Provide high-calorie drinks.