title: Nutritional screening of elderly patients: a health improvement approach to practice.
abstract: BACKGROUND
  Almost 60% of elderly care in-patients are at risk of malnutrition. Malnourished patients have poorer clinical outcomes and this is a key factor with respect to prolonging the length of stay. Since 2003, the Malnutrition Universal Screening Tool (MUST) has been advocated as a method for identifying these at-risk patients. Screening should take place on admission; however, the Trust has set a stretch target of aiming to document the score accurately within 6 h of admission.
  
  
  METHODS
  Three 'care of the elderly' wards participated in the project. Each month, the timeliness (within 6 h of admission) and accuracy (compared to a dietician assessment) of the MUST scores on the wards were reviewed. Plan-Do-Study-Act cycles were used to rapidly test changes in the ward areas. Tests included a study day, one-to-one ward-based nutrition training, a focus on the use of alternative anthropometric measurements, the development of a training pack and the identification of the challenges for undertaking accurate and timely assessments.
  
  
  RESULTS
  Baseline data identified that a MUST was documented in <60% of patients within 6 h of admission and that only 70% were accurate. After implementation of the change package, all the wards achieved an improvement and documented MUST within 6 h of admission; one ward achieved 90% accuracy in the scores.
  
  
  CONCLUSIONS
  Ward teams receiving training and monthly feedback of their results creates ownership, momentum and maintains enthusiasm for striving to reach stretch targets. The team continues to work on improving accurate nutritional screening across the Trust by using quality improvement methodologies.
authors.affiliation: Department of Nutrition and Dietetics, Salford Royal NHS Foundation Trust, Salford, UK.
authors.forename: K
authors.initials: K
authors.lastname: Farrer
authors.forename: E
authors.initials: E
authors.lastname: Donaldson
authors.forename: B
authors.initials: B
authors.lastname: Blackett
authors.forename: H
authors.initials: H
authors.lastname: Lloyd
authors.forename: C
authors.initials: C
authors.lastname: Forde
authors.forename: D
authors.initials: D
authors.lastname: Melia
authors.forename: S
authors.initials: S
authors.lastname: Lal
mesh_terms: D000368:Aged; D015577:Geriatric Assessment; D006760:Hospitalization; D006801:Humans; D044342:Malnutrition / Q000175:diagnosis*; D008403:Mass Screening; D015596:Nutrition Assessment; D009752:Nutritional Status; D010343:Patient Admission
keywords: Malnutrition Universal Screening Tool; quality improvement