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MUST screen

The nutrition screen on the RCSI list, and the number the RCSI Waterlow chart asks you for. Five steps from the BAPEN sheet: BMI score, unplanned weight loss score, acute disease effect, add them, then the management line. The arithmetic is yours: weight over height squared, and the loss as a percentage of the old weight. Marks go on the boundaries and the traps, so the cases sit on them.

In Ireland the screen is done on admission, within 24 hours at the latest, and repeated weekly for every inpatient (National Clinical Guideline No. 22, 2020). Two things the sheet does not print but assessors ask: oedema or ascites inflates the weight and can hide malnutrition, and if you cannot weigh or measure someone, ulna length gives height and a mid upper arm circumference under 23.5 cm means the BMI is probably under 20.

Source: BAPEN, ‘MUST’ Malnutrition Universal Screening Tool (must_full.pdf on the RCSI reading list, unchanged on 17.09.2026); Department of Health, National Clinical Guideline No. 22, Nutrition screening and use of oral nutrition support for adults in the acute care setting (2020); HSE Food, Nutrition and Hydration Policy for Adult Patients in Acute Hospitals (2018). Feeds into the Waterlow chart.

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 www.bapen.org.uk.