Exploring issues influencing the use of the Malnutrition Universal Screening Tool by nurses in two Australian hospitals

Abstract

Background: Nutrition screening using evidence‐based clinical practice is important for identifying patients whose nutritional status may be compromised, so that they receive appropriate treatment. Introduction of the Malnutrition Universal Screening Tool (`MUST') in two wards in two Melbourne hospitals resulted in low screening completion rates by nursing staff. Nurses’ screening practices were explored to understand personal and workplace barriers to compliance. Methods: Surveys of patients’ medical records and focus groups with nurses were used to gather data. Audio‐recorded group narratives were transcribed verbatim, and then coded thematically to develop understandings of response patterns. Results: A survey of admitted patients (n = 46) showed low screening rates by ward (17% and 62%). Eighteen nurses in two wards participated in three focus groups. The five main themes that emerged were: ‘screening role’, ‘task priorities’, ‘recognition of evidence‐based practice’, ‘uncertainty of protocols’ and ‘degree of competence’. Screening completion was limited by workloads, uncertainty about screening policy and also individuals’ skill in use of the tool. Conclusions: Application of `MUST' can be facilitated by increasing nurses’ competence through training and by the provision of ongoing support. When implementing nutrition risk screening, dietitians’ roles should include continually working with nurses to identify and reduce the barriers that prevent the adoption of universal screening. Enhancement of collaboration is essential to ensure that optimal nutrition care occurs.

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“…One action to overcome barriers with nutritional screening would be to program the calculation of BMI, percent weight loss and nutritional risk score into IT systems or allowing patients to input this data remotely supporting self-management; thereby reducing the amount of time the process takes. Patients could be given the option to screen at home as an alternative to screening during clinical visits [8,24], which would serve not only to reduce the burden on healthcare staff but also empower patients to be more involved in their own care [25]. However such a process would require availability of dietetic resources to formally review high risk cases.…”

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“…Porter et al 65 also reported low rates of compliance in 2 hospital wards as 17% and 62% in a survey of 46 admitted patients in Australia. The low compliance rate in this study also suggests that implementation of a nutrition screening tool within patient admission procedures does not automatically translate into nursing practice.…”

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“…Sağlık personelinin bu konuyla ilgili bilgi eksikliklerinin olduğu, rehberleri, protokolleri kullanmadıkları ve zamanlarının olmayışı da neden olarak gösterilmiş-tir. 28,39,40 Bu bulgular çalışmamızla benzerlik göstermektedir. Bizim hastanemizde de konuyla ilgili rehberler ve yazılı protokollerin bulunmayışı, bilgi eksikliğinin nedeni olarak gösterilebilir.…”

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