PWE-111 A pilot of the malnutrition universal screening tool (‘must’) in a general outpatient department

Introduction Early identification of patients who are (or are at risk of becoming) malnourished using a nutritional screening tool is vital to provide timely and effective nutritional interventions. NICE guidelines in 2006 (1) recommend screening for malnutrition using a validated tool in all adult patients on admission, and all outpatients at a first clinic appointment. We introduced ‘MUST’ in 2012 for all adult inpatients. Initial attempts to launch the tool across the outpatient department met with little success due to time taken to complete paperwork and perceived challenges of calculating the score. We modified the process in March 2017 to utilise the online tool available on the BAPEN website (2) . Methods 9 consultant-led clinics were chosen across gastroenterology, renal, colorectal surgery and respiratory. The BAPEN website was downloaded onto iPads and the nursing staff entered the relevant anthropometric measurements. A pre-printed coloured sticker (green, yellow, red) was placed in the notes detailing the ‘MUST’ score and recommended actions. Clinics from the first 3 weeks of the pilot were reviewed to determine compliance. Results 382 patients attended clinic across 3 weeks. 76 sets of notes were selected at random. 11 sets were unavailable leaving 64 for review. A sticker was present in 44/64 (69%) of notes, with no sticker in the remaining 31%. Conclusion The percentage of patients identified at risk of malnutrition (‘MUST’ score >1) was 25%; in keeping with published UK data (3) . In 73% of patients an action was documented by the clinician in response to the screening result. This demonstrates that implementation of ‘MUST’ is feasible in a busy outpatient department, and that in the majority identified as high risk an appropriate action plan was implemented. We plan to cascade it across the remaining outpatient areas and improve compliance by further training and education. NICE Clinical Guideline CG32: Nutrition support for adults: oral nutrition support, enteral tube feeding and parenteral nutrition (2006). BAPEN http://www. bapen. org. uk/screening-and-must/must-calculator Russell CA, Elia M. Nutrition screening surveys in hospitals in England, 2007–2011: A report based on the amalgamated data from the four Nutrition Screening Week surveys undertaken by BAPEN in 2007, 2008, 2010 and 2011: BAPEN; 2014.