The Malnutrition Universal Screening Tool (MUST) is a widely adopted and invaluable framework for assessing the risk of malnutrition in patients. It serves as a cornerstone of clinical practice, enabling healthcare professionals to identify individuals at risk and implement timely interventions to improve health outcomes. In the context of the Nursing and Midwifery Council (NMC) Objective Structured Clinical Examination (OSCE), the NMC MUST score is a critical component that underscores the importance of accurate nutritional assessments in patient care. By using this tool effectively, healthcare professionals can prevent complications related to malnutrition and support recovery through tailored interventions.
This blog provides an in-depth guide to the NMC MUST score and its application within the OSCE framework, ensuring that healthcare practitioners are equipped to use the tool confidently and competently. From understanding the key components of the scoring system to implementing evidence-based strategies for management, this guide offers practical insights into integrating the MUST tool into clinical practice. Whether you are preparing for the NMC OSCE or seeking to enhance your ability to deliver high-quality, patient-centered care, mastering the NMC MUST score is essential for promoting positive health outcomes and meeting professional standards.
NMC OSCE MUST Score Calculation
The MUST score is based on three key parameters:
- Body Mass Index (BMI)
- Unplanned Weight Loss (in the last 3-6 months)
- Acute Disease Effect (if the patient is acutely ill and likely to have no nutritional intake for more than 5 days)
Each factor is scored, and the sum of these points provides the overall MUST score, which indicates the level of malnutrition risk:
- 0 = Low Risk
- 1 = Medium Risk
- 2 or more = High Risk
NMC OSCE : Management Based on MUST Score
Low Risk (Score 0)
- Management:
- Continue routine care.
- No specific intervention needed beyond general advice on healthy eating and nutrition.
- Re-screen if the patient’s clinical condition changes.
- Follow-up:
- Reassess monthly in care homes.
- Reassess weekly in Hospital
- Reassess annually in community settings
Medium Risk (Score 1)
- Management:
- Monitor and document food intake for 3 days and offer diet modification advice to ensure sufficient intake.
- Consider a food-first approach (enhance meals with extra calories and protein).
- Encourage oral nutritional supplements if needed.
- Refer to a dietitian for more structured advice if required.
- Follow-up:
- Monitor and review the patient’s condition regularly. Hospital- Weekly, Care Home- at least Monthly, Community- 2-3 Months.
- If there is no improvement in nutritional intake or condition, escalate to high-risk management.
High Risk (Score 2 or More)
- Management:
- Immediate action is required to prevent further deterioration.
- Implement a nutritional care plan, including high-energy, high-protein diet advice, and oral nutritional supplements.
- Referral to a dietitian is essential for a detailed nutritional assessment and ongoing monitoring.
- Consider multidisciplinary involvement, including nursing staff, doctors, and other healthcare professionals, to address underlying issues such as chronic illness, disability, or acute illness.
- For patients unable to meet nutritional needs orally, consider enteral or parenteral nutrition if appropriate.
- Follow-up:
- Regular review (e.g., weekly in hospitals or monthly in care homes or community) to assess improvement, changes in weight, and overall health status.
- Adjust care plans as necessary based on the patient’s response to interventions.
NMC OSCE : MUST Care Pathway Example
- Step 1: Screen the patient using MUST.
- Step 2: Identify their risk (low, medium, or high).
- Step 3: Implement interventions based on risk.
- Step 4: Reassess and follow up based on the MUST guidelines.
By following this structured approach, healthcare professionals can effectively manage malnutrition risk, improve patient outcomes, and reduce complications
associated with poor nutritional status.
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