Inpatient Malnutrition Universal Screening Tool Template Page 2
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1
2Surname
First name
NHS Number:
Date of Birth:
DD MM YYYY
Height:_________(Measured/ Reported/ Calculated from Ulna length) Please circle.
Score
Score from
Score from
Total
Date and
Weight
BMI
from step
Step 2
Step 3
Risk of
Action
‘MUST’
Staff Signature
2
time
(Kg)
(Kg/m
)
1 (BMI
(Weight
(Disease
malnutrition
taken
Score
score)
loss score)
effect score)
Another
56Kg
19
1
0
0
1
Medium
Plan 1
EXAMPLE
Repeat screening weekly for all service users and record course of action
Key to abbreviations:
BMI = Body Mass Index
The ‘Malnutrition Universal Screening Tool’ ‘MUST’ is reproduced here with the kind permission of BAPEN (British Association for Parenteral and Enteral Nutrition)
For further information on ‘MUST’ see
Inpatient Units March 2013 for review March 2015
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