Do you currently screen your clients for malnutrition as part of your initial assessment?  When I’ve asked case managers this question at recent presentations and conferences, most admit this isn’t something they had ever considered. Here’s why this is important.

Over 3 million people in the UK are malnourished, and most of them live in the community.1 The National Institute for Health and Care Excellence (NICE) in their clinical guidance CG32, “Nutrition Support for Adults,” recommends that all adults be screened for malnutrition.  They recommend the screening be conducted: on admission to hospital, on the first outpatient appointment, on initial registration with a new GP and on admission to a care home.  It would therefore stand to reason that a client who has been through a catastrophic injury, should also have their risk of malnutrition assessed by a new case management team as part of their initial appointment.

A catastrophic injury puts people at very high risk of malnutrition.  Consider the following:

• 68% of people with brain injuries develop malnutrition during the first six months after their injury.2
• 44% of clients with spinal cord injuries are at risk of malnutrition when admitted to spinal cord injury units.3
• 22% of hospitalised orthopaedic patients are at risk of malnutrition.4

The purpose of screening is to catch problems early and get appropriate interventions in place to correct the problem.  This not only reduces the health risks associated with malnutrition, but can also allow clients and their support teams to implement healthy routines as early as possible.

Adequate nutrition is critical for a strong immune system, so when clients are not getting enough nutrition, they are more vulnerable to getting ill.  Malnutrition can also interfere with wound healing, contribute to muscle wasting and lead to nutrient deficiencies such as anaemia,5 all of which will interfere with someone’s rehabilitation.

How to screen for malnutrition

In the UK, the tool used to screen for malnutrition is the Malnutrition Universal Screening Tool (MUST).  You can download the full MUST document here or you can use the online MUST calculator here.  It factors in the client’s current BMI, unplanned weight loss in the last 3-6 months and whether the person is acutely ill and/or whether their food intake has been significantly affected.  The MUST tool will then give a score between 0-6 that rates the probability that a client is malnourished or at risk of becoming malnourished.  The higher the number, the higher the risk of malnutrition. If there is no height or weight information available, an alternative measure (such as mid-upper arm circumference) can be used instead. The goal of this screening is to know whether to refer on to a dietitian for additional assessment and intervention.  

Who can you refer to?

Local NHS dietetic departments will have varying criteria as to who can be referred to their service and the MUST score required for someone to be seen.  Many departments requires a referral from a GP, so please get in touch with your GP surgery initially.  The other option is to seek out a private/freelance dietitian by going to the Freelance Dietitians Website.   To refer a client or arrange MUST training for your staff, please get in touch at info@specialistnutritionrehab.co.uk or 0121 384 7087.  To have more blog articles such as this emailed directly to your inbox, please sign up for my newsletter below.