New self-screening tool aims to put patients in control of their nutrition

Nurses have welcomed the launch of a new self-screening tool to help identify adults in the community who are at risk of malnutrition.

The free, web-based tool, developed by the British Association of Parenteral and Enteral Nutrition (BAPEN), is a simplified version of the malnutrition universal screening tool (MUST), used in more than 80% of hospital and community settings across the UK to screen for malnutrition.

According to BAPEN, malnutrition affects at least three million people in the UK, with most cases arising in the community. It says around 15% of adults attending outpatient appointments and 10% of people presenting to their GP are malnourished.

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Malnutrition can lead to pressure ulcers, wound complications and respiratory disease, and can increase dependence, especially in older people. But BAPEN says if malnutrition is identified early, unnecessary suffering, hospital admissions and GP consultations can be avoided.

Surveys conducted by the association show that on admission to hospitals in the UK almost 30% of patients are at risk of malnutrition. It says much of this could be identified and treated in the community. Using the new self-screening tool, an individual who is ill, has lost weight recently or is worried about weight loss can assess their own risk of malnutrition.

The tool (see box, below) allows adults to calculate their risk of malnutrition and provides them – and their health professional – with information about what to do if they are at high risk.

Prevalence of malnutrition

It is estimated that malnutrition affects:

35% of residents in care homes.

34% of adults on hospital wards.

30% of adults on admission to hospital.

18% of adults on admission to mental health units.

15% or more of adults attending hospital outpatients.

12-14% of adults in sheltered housing.

10% of adults visiting their GP.

5% of the adult population in England.

Source: NIHR Southampton Biomedical Research Centre and BAPEN

RCN professional lead for older people and dementia care Dawne Garrett says the tool could help people take greater control of their nutritional needs.

‘When assessing older patients in the community, nurses should look at their ability to perform tasks such as cooking and shopping’ – Dawne Garrett

‘As nurses, we need to make sure that the people we care for are well educated, and feel able to take some control over their health,’ she says. ‘If people use this tool and see they are getting good results from changing their diet, it can give them a sense of empowerment.’

Greater awareness

National Nurses’ Nutrition Group chair Liz Anderson hopes the tool will help raise awareness of malnutrition among the public. She says a recent report from the Patients Association shows that many people still do not understand how malnutrition can affect your health.

‘If primary and secondary care can show patient groups this tool, and encourage people to use it, that can only be a good thing,’ she adds.

Hounslow and Richmond Community Healthcare NHS Trust tissue viability service lead Edwin Chamanga says the self-screening tool could be used by carers to help identify weight loss and malnutrition risk in patients.

‘One of the biggest challenges we have in practice is different carers visiting every day, making it difficult to benchmark care,’ he says. ‘If this was used as part of a patient’s care plan, information on weight could be easily recorded and monitored.’

Self-screening could allow patients to present to the GP or practice nurse with knowledge of their malnutrition risk, says Stephanie Cumming, a practice nurse in Warwickshire, but she adds the online tool will not be suitable for everyone. ‘Many older people may be reluctant or unable to use it because the tool is online. As they are one of the highest risk groups for developing malnutrition, there is a concern that they may slip through the net.’

Ms Garrett says older people are more likely to have underlying health problems that can increase their risk of becoming malnourished, and that nurses have to ‘dig deeper’ if older people say they are eating well.

‘Nurses know that a good diet is not just about calories, but about having the right nutrients. When assessing older patients in the community, nurses should look at their ability to perform tasks such as cooking and shopping, and their relationship with food. Is it something they relish, or has it become a chore to them?’

The launch of the tool coincides with the publication of a new report that shows the economic burden of malnutrition on health and social care services.

The report, produced by BAPEN and the National Institute for Health Research Southampton Biomedical Research Centre, found that malnutrition cost an estimated £19.6 billion in England in 2011/12, more than 15% of total public spending on health and social care. About half of that figure relates to older people, the rest to younger adults and children.

Analysis of the figures has suggested that health and social care services could save between £172 million and £229 million a year through better screening and implementing appropriate nutritional care pathways, as recommended in National Institute for Health and Care Excellence guidelines.

The malnutrition self-screening tool

The British Association of Parenteral and Enteral Nutrition’s (BAPEN) new self-screening tool is based on the malnutrition universal screening tool it developed more than ten years ago.

It uses height and weight status, history of weight loss and body mass index to calculate malnutrition risk. Data can be entered in imperial or metric measurements.

People at risk of malnutrition can download a dietary advice sheet with basic information and suggestions for improving their nutritional intake.

The advice originates from the malnutrition pathway (, which provides guidance to health professionals on the management of malnutrition in the community.

Co-designer of the tool and BAPEN malnutrition action group member Christine Russell says it could also help family members who are concerned about weight loss and change of appetite in a loved one who is unwell.

Access the tool at

Report author Marinos Elia, professor of clinical nutrition and metabolism at the University of Southampton, says: ‘We recognise there are some costs attached to more screening, more care plans and more nutritional support.

‘But, ultimately, it is more expensive not to treat malnutrition than to treat it.’

Chief nursing officer for England Jane Cummings says NHS commissioners should use the information in the report to support the implementation of recently published guidance from NHS England on commissioning nutrition and hydration.

Read the malnutrition report at

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