Malnutrition Universal Screening Tool (MUST) Practical Work

Step 1: Calculating BMI

1. Height & weight:

Write your height and weight below (this can be recalled or an actual measurement). You
do not have to share your personal measurements with anybody else; this is solely for
your training purposes.

Recalled height Recalled weight

2. Body Mass Index (BMI):

a. This is calculated by dividing your weight in kg by your height in m 2 (height x height)
b. It is easier to use the BMI chart provided in step 1 of the MUST (page 2). Using
your recalled height and weight:
 Find your height in meters along the bottom of the BMI chart
 Find your weight in kg down the left hand side of the BMI chart
 Follow the lines along from the left and up from the bottom at these two
points. Where they meet will be your BMI.

Record your BMI ………………………………………………………………………………...

3. Estimating height from ulna length:

Turn to the last page of the MUST where you will see ‘Alternative measurements’.
a. Measure between the point of the elbow and the midpoint of the prominent bone of
the wrist (left if possible).
b. Record this measurement in centimetres ………………………………………………
c. Using the ulna length table in the MUST, look along the beige lines to find the
number that corresponds with your ulna length measurement
d. Look above this number for men and below this number for women. There are two
numbers for each gender shaded blue. The upper one gives an estimated height for
men/ women under 65yrs, the lower one for men/women over 65yrs.

 Record your estimated height here ………………………………………………………

 How similar is it to your actual height? …………………………………………..............
 Which was more reliable? your recalled or your estimated height?
…………......................................................................................................................
 What is your BMI worked out using your estimated height?
………………………………………………………………………………………………...
 How different is it from your actual BMI? Are still in the same BMI band? …..............
Step 2: Recent Unplanned Weight Loss:
 Unplanned weight loss over 3-6 months is a more acute factor for malnutrition than
BMI.
 An unplanned weight loss of more than (>)10% is clinically significant
 An unplanned weight loss of 5-10% is an early indicator of increased malnutrition
risk.

Practice:

a. One of your residents weighs 62kg today. When they

were weighed 6 months ago, they were 70kg

How much weight have they lost in kg? …………………………………………………

b. Using the weight loss score tables in MUST (page 4), calculate what percentage of
body weight they have lost over this time?
……………………………………………………………………………………………….
c. What is their score for step 2 of MUST? ………………………………………………...

Step 3: Acute disease effect score

This step is only to be used when a patient is acutely ill and there has been or is likely
to be no nutritional intake for >5 days. You are unlikely to come across this kind of
patient in a care home setting because ultimately if one of your residents is acutely ill, it
is likely that they will have required an admission to hospital.
 Case Studies

1. Mrs White (screening & setting up a care plan)

 Mrs White was born on 9th April, 1940. She has just become a resident at your care
home, and your colleagues are carrying out her admission screening.

 Her weight today is 50kg, 3 months ago she was 52kg and 6 months ago she was
54kg.

 She can’t remember her height, and your colleagues are unable to measure it as
they do not have an accurate height measure. Instead they measure her ulna
length which provides a measurement of 23.5cm.

 She is not acutely ill and is still eating.

Fill in the following:

Her calculated Step 1 Step 2 Step 3 Step 4

height BMI score unplanned acute disease Overall risk of
weight loss effect score malnutrition
score score

Which risk group does she fall into……………………………………………………………….

Using the local care home MUST management guidelines to give you a general idea of
what treatment would be suitable for Mrs White, fill in 4 – 5 actions for her care plan.
Think of actions suited to the individual resident that are also practical in your care home
and very specific so that everyone who looks at the plan can understand exactly what was
decided.

1.

2.

3.

4.

5.
 2. Mr Brown (evaluating and developing a care plan & menu adaptation)

 Mr Brown is 90 years old, and he became a resident at your care home 3 days ago. He
has type 2 diabetes.

 On admission he was screened for malnutrition and his weight was 59kg, and reported
his height is 1.78m. This gives him a BMI=19kg/m2, and his BMI score (step 1) is 1.

 6 months ago he weighed 63kg. He has lost 4kg in this time. His percentage weight
loss, therefore, is 6.4%, which gives him a % weight loss score (step 2) of 1.

 He is not acutely ill and is eating, so his acute disease effect score (step 3) is 0.

From the information above:

a. What MUST score (step 4) would you give him?

Fill in on his care plan below
b. What risk group does this put him in?

 Look at the day’s menu provided overleaf. Study all of the choices, and write down ways
in which you would add calories/protein to the foods. Don’t forget extra drinks and
snacks in between main meals.

 Are there any ways you can think of to incorporate fruit and/or vegetables into high-
protein, high calorie recipes?

 Fill in the ‘actions part of his care plan with some of the ideas. Be specific.

Breakfast:

Lunch:

Evening Meal:

Between meal snacks/drinks:

 Breakfast Mid-am Lunch Mid pm Evening meal Evening

Tea or
Fruit juice or tinned Tea or Fruit juice/water Tea or Fruit juice/water coffee
fruit coffee coffee
cream of vegetable Tomato soup
Cereal/porridge soup with bread roll
Sandwich
Bread/toast Minced beef & onion selection or
cobbler or cheese and poached eggs on
Marmalade/jam potato pie or sliced toast
ham
Bread & butter
Tea/coffee New potatoes/ jam/honey
creamed potatoes
Cake selection,
Peas/shredded strawberry milk
cabbage jelly, ice-cream,
fresh fruit
Salad bowl

Bread & butter pudding

& custard, yoghurt,
ice-cream, fresh fruit,
cheese and biscuits

Care Plan – use local MUST management guidelines provided

Name: Mr Brown Date of Birth: 01.01.1930 NHS 0000000000000

Number:

Pre- Height: 1.78m Weight 3 – 6 63kg

assessment Actual/recalled/ months ago or
details: estimated from usual weight:
ulna length

Date Present Step 1: Step 2: Step 3 (if appropriate) Step 4: Signed

weight (kg) BMI Score Weight Acute disease Overall risk of
loss score effect score malnutrition score
Today’s 59kg 1 1 0
date

Actions Initiated: Evaluation:

1.
2.
3.
4.
5.
6.
Signature: Review date: