Managing Adult Malnutrition
Including a pathway for the appropriate use of
oral nutritional supplements (ONS)
Identification of Malnutrition: Nutrition Screening
Identify malnutrition by using a validated screening tool such as the ‘Malnutrition Universal Screening Tool’ (‘MUST’)1 - see bapen.org.uk
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WHEN TO SCREEN
Opportunistically - on first contact within a new care setting e.g. upon registration with GP, outpatient appointment, on admission to a hospital or care setting29, 30, contact with Community/District Nurse, during pharmacist-led medication reviews (particularly for individuals on polypharmacy), during annual disease reviews, pre-operative assessments, specialist community clinics for ‘at-risk’ groups and at dental appointments.
Also consider groups at risk of malnutrition.
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RECOMMENDED SCREENING FREQUENCY
Once an individual has been identified as at risk of malnutrition, further assessment, treatment and repeat screening are recommended to evaluate improvement, deterioration and the need for further action29.
Frequency of screening will depend on the individual and their requirements, needs and TREATMENT GOALS and should reflect local and national policy and guidance.
Consider how nutrition screening and the Malnutrition Pathway resources, might be embedded into existing care pathways to trigger early action in conditions that pose a high risk of malnutrition e.g. COPD, frailty.
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ASSESSMENT: IDENTIFYING THE UNDERLYING CAUSE OF MALNUTRITION
For all individuals who are malnourished, or at risk, it is important to consider the underlying cause to help identify the most appropriate nutritional care. Remember that some treatments and medications can have side effects which can impact on nutritional status, eating and drinking. Dietary advice leaflets to provide further ideas on managing the diet-related problems/symptoms that are interfering with food intake can be found HERE and may also be available from local nutrition and dietetic departments. In some cases referral to relevant specialities may be required.
Identifying the causes and symptoms, which are interfering with the ability to eat and drink, and addressing those that can be reversed or modified should be an integral component of the treatment plan.
Managing Adult Malnutrition
Oral Nutritional Supplements: Where individuals require (or already have) a prescription of ONS, this pathway will guide you in setting goals, deciding on dose and duration of ONS, how and when to monitor progress and when to discontinue prescription.
A Guide to Managing Adult Malnutrition in the Community: the complete document is available.
Resources
A selection of publications for use by healthcare professionals, patients and carers are available in the resources section of the website.
Support for Patients & Carers
A number of resources are available that have been developed to support patients and carers.
Further Information
We can be contacted regarding the malnutrition pathway materials and website
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