- White J.V.
- Guenter P.
- Jensen G.
- Malone A.
- Schofield M.
Screening and Malnutrition Universal Screening Tool (MUST).
Position Statement Development Process
|Definition: Nutrition screening is the process of identifying patients, clients, or groups who may have a nutrition diagnosis and benefit from nutrition assessment and intervention by a registered dietitian nutritionist (RDN).|
|TOOL||Sensitivity||Specificity||Positive Predictive Value||Negative Predictive Value||OVERALL VALIDITY|
Implication for Practitioners
- •Assume a strong leadership role in implementing the MST. A benefit to society occurs if individuals who may have malnutrition obtain nutrition assessment and intervention services from an RDN. This benefit is not without cost because of the time required for an RDN to complete a nutrition assessment. Thus, the impact of changes to screening procedures affects the amount of RDN time available to provide other required nutrition services and provides justification for RDNs to select and oversee implementation of malnutrition screening tools.
- •Implement the MST without changes to the wording of the questions or the scoring system for referrals as originally presented.6Adding items, modifying questions, or interpreting scores differently than intended by the authors of the tool should be avoided, as these changes invalidate the MST. Individual patients or clients with an MST score of ≥2 should achieve the greatest benefit from an RDN referral.
- •Provide ongoing training to paraprofessionals who administer the MST and monitor the impact of the screening and referral process by summarizing data from individuals with malnutrition.
- •Abandon all unvalidated malnutrition screening tools (eg, pressure injury and illness severity tools), including tools that were validated, then modified without rigorous re-validation against a standard definition of malnutrition.
- •Discourage strongly the development of new screening tools in favor of further validating existing tools,13especially in adults between the ages of 19 and 49 years, over age 90 years, and in community and long-term care settings.
- •Research the costs and outcomes of the malnutrition screening procedure. Minimal data exist on the financial implications of the proper identification of patients who do or do not have malnutrition or the costs of the screening procedure.4,
- •Research the minimum level of education and training needed to accurately administer the MST and develop education and training materials to facilitate consistency among users.
- •Develop partnerships with patient advocacy groups, other health care professional organizations, and policy makers to implement the MST.
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The Academy of Nutrition and Dietetics develops position papers to assist in promoting the public’s optimal nutrition, health and well-being. This position was adopted by the Council on Research on August 6, 2019. This position is in effect until December 31, 2027. All requests to use portions of the position or republish in its entirety must be directed to the Academy at [email protected] .
Authors: Annalynn Skipper, PhD, RD (American Medical Association, Chicago, IL); Anne Coltman, MS, RD, LDN, CNSC (Trinity Health, Melrose Park, IL); Jennifer Tomesko, DCN, RD, CNSC (Rutgers University, School of Health Professions, Newark, NJ); Pamela Charney, PhD, RD (University of North Georgia, Dahlonega, GA); Judith Porcari, MBA, MS, RD (Lehman College, Bronx, NY); Tami A. Piemonte, MS, RDN, LD/N (Academy of Nutrition and Dietetics, Evidence Analysis Center, Chicago, IL); Deepa Handu, PhD, RD, LDN (Academy of Nutrition and Dietetics, Evidence Analysis Center, Chicago, IL); Feon W. Cheng, PhD, MPH, RDN, CHTS-CP (Academy of Nutrition and Dietetics, Evidence Analysis Center, Chicago, IL).
STATEMENT OF POTENTIAL CONFLICT OF INTEREST The authors of the paper have no conflicts to disclose. A. Skipper is an employee of the American Medical Association (AMA), but the ideas expressed in this position are those of the Academy of Nutrition and Dietetics and do not reflect AMA policy.
FUNDING/SUPPORT There is no funding to disclose.
Reviewers: Constantina Papoutsakis, PhD, RDN (Academy of Nutrition and Dietetics, Chicago, IL); Jason Switt (Academy of Nutrition and Dietetics, Chicago, IL); Jill Bala Kohn, MS, RDN, LDN (Academy of Nutrition and Dietetics, Chicago, IL); Sharon M. McCauley, MS, MBA, RDN, LDN, FADA, FAND (Academy of Nutrition and Dietetics, Chicago, IL); Marsha Schofield, MS, RD, LD, FAND (Academy of Nutrition and Dietetics, Chicago, IL). This position paper was made available for Academy member feedback.
Systematic Review Workgroup: The authors would like to thank Erin Pover, MS, RDN, CSOWM, LDN (Workgroup member from 2016 to March 2018), Kathy Hoy, EdD, RDN (lead analyst from 2016 and July 2017), and Margaret Foster, MS, MPH, AHIP (librarian) for their contributions to this project. A full listing of the systematic review project team is available on www.andeal.org/nsa.