West Suffolk NHS Foundation Trust, Bury St Edmunds, UK.
Norfolk & Norwich University Hospitals NHS Foundation Trust, Norwich, UK.
Int J Risk Saf Med. 2022;33(S1):S57-S61. doi: 10.3233/JRS-227025.
Malnutrition adversely affects clinical outcomes, necessitating a prompt and accurate assessment of nutritional status on admission. A variety of tools exist to aid nutritional assessment, of which the malnutrition universal screening tool (MUST) is recommended, but remains difficult to implement in practice.
The aim of this audit was to improve the utilisation of the malnutrition universal screening tool (MUST) in the Acute Medical Unit (AMU) at Queen Elizabeth Hospital, King's Lynn. Specifically, patients should have a completed and accurate MUST score within 6 hours of arrival to AMU and high-risk patients (MUST score ≥2) should be referred to dieticians within 48 hours of admission. The first cycle was conducted by March 2019 and the second cycle was completed 1 year later to allow assessment of interventions actioned after the first cycle.
We conducted a two-cycle audit evaluating the MUST completion and dietician referral rate of high-risk patients (defined as MUST ≥2) on the Acute Medical Unit in a district general hospital, with the standards of 80% and 100% respectively. A questionnaire was distributed after the first cycle exploring nurses' current experience and competence in using MUST.
In the first cycle, MUST scores were calculated correctly in 111/150 patients (74%) and 1/9 (11%) high-risk patients were referred to dieticians. After interventions, MUST scores were calculated correctly in 77/101 patients (76%) and 2/4 high-risk patients (50%) were referred to dieticians. The nurses (n = 19) who took part in the questionnaire felt confident in MUST completion, but the average score in an objective assessment was 67%.
As per the literature, the first cycle demonstrated the under-utilisation of MUST in clinical practice. In response, we proposed additional face-to-face training for existing staff, the inclusion of an e-learning module within the staff's induction, and provision of ward MUST 'troubleshooting' booklets. MUST utilisation rates improved upon re-auditing, but not to target standards. We will need to consider potential barriers to sustainable change and implement interventions such as identification of nursing champions to overcome them.
营养不良会对临床结果产生不利影响，因此需要在入院时迅速准确地评估营养状况。有多种工具可用于营养评估，其中推荐使用营养不良通用筛查工具（MUST），但在实际中实施起来仍较为困难。
本审计旨在提高伊丽莎白女王医院金斯顿急症医学科（AMU）对营养不良通用筛查工具（MUST）的使用。具体而言，患者应在抵达 AMU 的 6 小时内完成并准确记录 MUST 评分，而 MUST 评分≥2 的高危患者应在入院后 48 小时内转介给营养师。第一轮审核于 2019 年 3 月进行，第二轮审核于一年后完成，以便评估第一轮审核后采取的干预措施的效果。
我们进行了两轮审核，评估了一家地区综合医院急症医学科高危患者（MUST 评分≥2）的 MUST 完成情况和营养师转介率，标准分别为 80%和 100%。第一轮审核后，我们发放了一份问卷，以了解护士在使用 MUST 方面的当前经验和能力。
第一轮审核中，在 150 名患者中，有 111 名（74%）患者的 MUST 评分计算正确，9 名高危患者中有 1 名（11%）被转介给营养师。干预后，在 101 名患者中，有 77 名（76%）患者的 MUST 评分计算正确，4 名高危患者中有 2 名（50%）被转介给营养师。参与问卷调查的护士（n=19）对 MUST 的完成感到有信心，但在客观评估中的平均得分为 67%。
根据文献，第一轮审核显示 MUST 在临床实践中的使用率较低。针对这种情况，我们提出了对现有员工进行额外的面对面培训、在员工入职培训中加入电子学习模块，并提供病房 MUST“故障排除”手册。重新审核后，MUST 的使用率有所提高，但仍未达到目标标准。我们需要考虑可持续变革的潜在障碍，并实施干预措施，如确定护理方面的拥护者，以克服这些障碍。
