34.4 MUST
Five minutes on admission, three scores, one action — identify malnutrition risk before the patient deteriorates from something that was preventable
What it is
The Malnutrition Universal Screening Tool (MUST), developed by BAPEN. A validated five-step screening tool that takes under five minutes and produces a risk score that directly determines the care pathway. Must be completed on admission and weekly thereafter. Malnutrition affects 20–30% of hospital patients on admission and is directly associated with increased infection rates, longer stays, and higher mortality.
ASF criterion
Evidence for: Hospital Standard 4, criterion 4.24 (Core) — Nutrition and Therapeutic Diet Needs Are Actively Managed.
| MUST SCREENING FORM · Patient: ID: Date: | ||
|---|---|---|
| STEP 1 — BMI Score | ||
| BMI >20 kg/m² | Score = 0 | ☐ |
| BMI 18.5–20 kg/m² | Score = 1 | ☐ |
| BMI <18.5 kg/m² | Score = 2 | ☐ |
| STEP 2 — Unplanned Weight Loss in Past 3–6 Months | ||
| <5% weight loss | Score = 0 | ☐ |
| 5–10% weight loss | Score = 1 | ☐ |
| >10% weight loss | Score = 2 | ☐ |
| STEP 3 — Acute Disease Effect | ||
| Patient is acutely ill AND has had or is likely to have no nutritional intake for >5 days | Score = 2 | ☐ |
| TOTAL MUST SCORE (Steps 1+2+3): | ||
| Score 0 — Low risk | Routine clinical care. Repeat screening: weekly (hospital), monthly (LTC). | |
| Score 1 — Medium risk | Observe. Document dietary intake for 3 days. Repeat screening weekly. Refer to dietitian if not improving. | |
| Score 2+ — High risk | Refer to dietitian within 24 hours. Improve and increase overall nutritional intake. Set specific goals. Monitor weekly. | |
| Action taken: Completed by: Date: | ||
ASF-TOOL-EWD-04 · Toolkit 34 — Early Warning & Deterioration · france-asf.fr/tools · MUST © BAPEN 2003, reproduced with permission for clinical use · ASF layout CC BY-NC-SA 4.0 · Keep this line on all adapted versions
