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Aim Malnutrition is a cause and a consequence of disease in older patients admitted to hospital. It is often under-recognised and under-treated. Early identification of those with, and at risk of malnutrition, is vital. Improve identification of malnutrition, through screening and assessment of older patients on admission to hospital.
Methods An initial audit reviewed all admissions to the acute elderly unit (AEU) prospectively over a two-week period from 8-28 July 2013 (inclusive). Bedside and medical notes, including the nutrition pathway, were examined for each patient. The pathway was a key document, requiring completion by nurses within 12 hours of admission. From this, the ‘Malnutrition Universal Screening Tool’ (MUST) score was calculated. The score determined actions. A MUST score of 2 or more, required referral to a dietician.
The data was analysed with Excel.
Interventions took place through a programme of face-to-face teaching sessions with nursing staff on each ward, along with updates for ward managers. A re-audit was carried out (prospectively) from 20 January– 2 February 2014.
Results 199 admissions were analysed over the initial audit period. The average age was 86.3 years and weight 61.9 kg. 66% of patients had weight and 28% had height, measured on admission. 55 % of patients had a MUST score calculated. MUST cannot be scored without measurement (or estimation) of height. 34% of patients had a MUST score of zero, 8.5% score of one and 13% had a MUST score of two or more. 48% of those eligible were referred to a dietician.The re-audit analysed 191 admissions, with an average age of 85.7 years and weight 61 kg. 81% had weight, and 65% had height, measured. 82% of patients had a MUST score documented. MUST scores of 2 or more were comparable in the two periods, with a higher referral rate to dieticians (74%) during re-audit.
Conclusion The initial audit demonstrated screening and provision of basic nutritional care was below standards. Weights and heights were under reported, therefore making it difficult to screen malnutrition through the MUST score. This project improved screening of malnutrition through a simple but effective programme of teaching frontline nursing staff, resulting in a increase in recording of heights and weights and subsequent MUST scoring. This helped deliver high quality care for malnourished patients, allowing early specialist interventions.