Revising Malnutrition Universal Screening Tool with Evidence-Based Adjustments

Abstract/ Executive Summary
Author: Constantin Mircea
Introduction
Malnutrition significantly affects global health, compromising physical health, immunity, and recovery outcomes. MUST, widely used in NHS trusts, evaluates nutritional risk using BMI, weight loss, and acute disease effects. However, inconsistencies between MUST’s BMI thresholds and WHO standards create challenges, with the BMI range 18.5–19.9 classified as ‘underweight’ in MUST but ‘healthy’ by WHO. This misalignment risks overdiagnosis and unnecessary interventions. The proposal aims to realign BMI thresholds using a systematic review of evidence, ensuring that malnutrition risk identification becomes more accurate and consistent.
Background
A comprehensive analysis using SWOT, PEST, and root cause frameworks reveals that MUST's strengths include its widespread use and integration into clinical practice. However, weaknesses such as misaligned BMI thresholds and variable implementation within NHS trusts undermine its reliability. Aligning MUST with WHO standards could enhance accuracy, reduce unnecessary interventions, and improve resource allocation. Challenges include resistance to change and resource constraints. Strategic stakeholder engagement, training, and policy integration are identified as solutions to these barriers.
Literature review
The search target leading academic databases and sources known for their comprehensive coverage of healthcare and clinical research such as PubMed/Medline, CINAHL (Cumulative Index to Nursing and Allied Health Literature), Google Scholar, using PICO framework. From a total of 101 results, 5 primary research studies were included in the literature review. The findings highlight significant variability in malnutrition prevalence across different screening tools. Studies advocate for incorporating complementary metrics, such as muscle mass and dietary intake, to improve diagnostic precision. The review reinforces the need for revising BMI thresholds within MUST to ensure alignment with global standards. Addressing these gaps could promote consistent malnutrition risk assessments, reduce healthcare costs, and enhance clinical decision-making.
Proposed resolution
The proposal outlines specific objectives, including reclassifying the BMI range of 18.5–19.9 as ‘healthy’ and conducting a pilot study to evaluate the revised tool. The Plan-Do-Study-Act (PDSA) cycle will guide implementation, supported by SMART objectives to ensure measurable and achievable goals. Training programs for healthcare staff and stakeholder feedback mechanisms will support adoption. Metrics for success include improved screening accuracy, reduced unnecessary interventions, and enhanced patient and staff satisfaction.
Justification
Evaluation frameworks, including the PDSA cycle, Kirkpatrick Evaluation Model, and Theory of Change, will assess the revised tool's impact. Sustainability will depend on embedding changes into policies, integrating them into electronic health records (EHRs), and promoting a culture of evidence-based practice. Proactive strategies to manage resistance to change and initial resource constraints are critical to ensuring long-term success. Disseminating findings through peer-reviewed journals, conferences, and stakeholder reports will ensure transparency and encourage widespread adoption. Updated NICE and BAPEN guidelines will formalise the revisions.
Conclusion
Revising MUST offers an opportunity to align malnutrition screening with global standards, enhance diagnostic accuracy, and optimise healthcare delivery. This evidence-based initiative prioritises patient outcomes, service efficiency, and professional engagement, contributing to the global engagement and tackle malnutrition.
*To read the piece of research in full, please email us with your request and we will send the pdf to you.

Mental Health Staff Nurse at Coventry and Warwickshire Partnership NHS Trust.
Trained Leader and Experienced Manager. Trained Mediator. Former Basketball Player.
Constantin Mircea
MSc Mental Health Nursing graduate 2025
Comments