The Nutrition Screening Steering Group in Beaumont Hospital, Dublin recently evaluated the introduction of the Malnutrition Universal Screening Tool (MUST) on one medical and one surgical ward, as an initial step for introducing Hospital-wide screening.
The aims of the Nutrition Screening Steering Group were:
- To determine impact on average length of hospital stay (ALOS) as the primary outcome.
- To assess effects on secondary outcomes: dietetic activity levels and use of nutritional products (oral nutritional supplements and enteral feeds).
- To seek nursing feedback on introduction and use of MUST.
- To work within current staffing and budget constraints.
Results of the study found that the medical ward had 87% compliance with use of the MUST tool and showed a 3 day reduction in ALOS during the intervention period. Nurse champions were evident on this ward and motivation was high. The surgical ward showed lower compliance (29%) with MUST. A higher turnover, a shorter lead-in period and a reduction in key nursing staff, may have impacted on this. A smaller decrease in ALOS was seen compared with the medical ward, although this was still above the hospital average.
Dietetic activity levels were similar before and during the intervention period. No significant difference was noted in the cost of nutritional products used on the medical ward over the intervention period. Differences on the surgical ward cannot be attributed to nutrition screening alone (lower compliance). Nursing satisfaction survey results reveal that nurses perceive MUST as relatively time-consuming. More training and experience with the tool may help improve this perception.
Nutrition screening may have allowed for more efficient use of beds particularly on the medical ward, driving down LOS, thereby freeing up capacity. This in turn may have a potential impact on the Emergency Department extra capacity which currently costs €71,000 per week to have open. It is hoped that the tool will become part of standard nursing admission documentation and will be rolled out hospital-wide.
This study was awarded best quality initiative poster presentation at Beaumont Hospital's Clinical Audit and Patient Safety Day on 1st May 2014.