Post Webinar Recap: “Ineffectively screened patients waste already overstretched dietetic resources.”

The following article provides a summary of the key insights and discussions from our recent webinar, "Ineffectively screened patients waste already overstretched dietetic resources", which took place on 3 March 2026.

During the session, we debated the importance of accurate nutritional screening, common errors in the use of the MUST tool, and how improving screening practices can help ensure patients at risk of malnutrition receive timely and appropriate dietetic care.

Here are some of the highlights discussed:

Why nutritional screening matters

• Around 5% of the population in England and 29% of hospital patients are affected by malnutrition
• Malnutrition increases the risk of disease, delays recovery and leads to longer hospital stays and higher healthcare use.
• Effective treatment of malnutrition can result in:
  • 9% reduction in serious adverse events
  • 7% reduction in mortality
  • Lower infection rates
  • Shorter hospital stay
• Average healthcare costs are estimated at £7,408 per year for a malnourished patient compared with £2,155 for someone well nourished.
• Early identification through nutritional screening is therefore critical to enable timely intervention.

MUST screening: A Quick Reminder

In the UK MUST is the most commonly used endorsed screening tool, with resources and training supported by BAPEN.

To complete MUST screening:

1. Measure height and weight
2. Calculate BMI
3. Calculate percentage weight loss
4. Consider acute disease effect
5. Add scores to determine malnutrition risk
6. Follow the management pathway and refer when appropriate

Accurate data collection is essential, as incorrect measurements or calculations can lead to underestimation of malnutrition risk and delayed intervention.

Do’s and Don’ts of Nutritional Screening

Common screening errors and best practice

Evidence from audits and quality improvement projects shows that inaccurate screening can lead to patients being missed or referred late for dietetic care.

1. Inaccurate height or weight data

Issue: Height measurements may be incorrect or inconsistent across records, affecting BMI calculations and MUST scores.

Best practice:

• Check previous records if height appears inaccurate
• Use verified measurements where possible

2. Weight loss not calculated properly

Issue: Weight loss is often not calculated using the 3- and 6-month comparisons required for MUST scoring.

Best practice:

• Review previous weights in the patient record
• Calculate percentage weight loss correctly before assigning the MUST score

3. Malnutrition risk underestimated

Issue: Audits have found that MUST scores frequently underestimate malnutrition risk.

Best practice:

• Recheck BMI, weight loss calculations and acute disease effect scoring
• Ensure staff are trained in correct use of the MUST tool

4. Alternative measurements not used when BMI cannot be calculated

Issue: Some patients (e.g. amputees) do not have appropriate alternative anthropometric assessments recorded.

Best practice:

• Use appropriate alternative measures when BMI cannot be accurately calculated

5. High-risk patients not referred

Issue: Studies show that patients with high MUST scores are sometimes not referred to dietetic services.

Best practice:

• Ensure screening results trigger the correct referral pathway
• Link screening directly to action and care planning

Key questions the webinar answered 

One of the common issues in clinical practice is that screening often happens but doesn’t always lead to action, where do you think the pathway most commonly breaks down?

Even though screening rates in a lot of trusts are high, screening alone does not improve outcomes unless it triggers a clear, timely clinical response.

Some of the most common reasons for pathway breakdowns include: 

• Lack of clear escalation pathways. A frequent issue is that staff complete the screening tool but are uncertain about what actions to take when a patient scores at risk. If escalation pathways are unclear, screening results may simply be recorded without triggering the appropriate response.
• Workload and time pressure. Even when staff know what action is required, workload and competing clinical priorities can delay or prevent follow-up. For example, initiating food-first strategies, documenting nutrition care plans, or arranging referrals may be deprioritised in busy wards, particularly if malnutrition risk is perceived as less urgent than other clinical issues. What is more, in busy clinical environments, referrals may sometimes be made verbally rather than documented through electronic systems, which increases the risk of them being overlooked or lost (Dent et al. 2019).
• Inaccurate screening. Sometimes screening is conducted in an inaccurate manner - with one of the most common mistakes being underestimation of nutritional status.  As a result, patients may technically be screened but still not be identified as at risk. This means they are not referred to dietetic services or appropriate nutritional support, even when they would benefit from further assessment and intervention (Geiker et al. 2012).

How can we best support nursing staff to complete MUST on admission, given the competing demands and paperwork burden, while also ensuring it is done accurately?

Some of the practical strategies can include:

• Pre-populating data where possible: Height, weight, and previous nutritional information can be auto-filled from electronic health records to save time.
• Practical training sessions: Focus on practical scenarios rather than theory to minimise additional burden - e.g., “how to measure BMI if patient cannot stand.” (Burden Brierley, 2014)
• Delegation and role clarity: Some tasks, like weight measurement, can be delegated to healthcare assistants under supervision, leaving nurses to complete the scoring and intervention plan. (Porter et al. 2009)
• Celebrating compliance:Recognise staff or wards achieving high completion and accuracy rates to reinforce positive behavior. 

How can care homes ensure that staff receive and maintain appropriate training in nutritional screening and the use of the MUST tool, despite high staff turnover?

High staff turnover in care homes can make it difficult to maintain consistent knowledge and competency in nutritional screening and use of the MUST tool. A sustainable approach is to embed routine training sessions, so that new staff can quickly gain the required skills and existing staff maintain competence (NICE, 2017).

• Incorporate training into induction. All new staff should receive basic nutrition and MUST training as part of their induction programme. This ensures that every new employee understands the importance of screening, how to complete the tool, and when to escalate concerns. Embedding it into induction prevents gaps when staff turnover is high.
• Provide regular refresher training sessions. Short annual or bi-annual refresher sessions help reinforce knowledge and maintain competency. These can be brief workshops, team meetings, or online modules that review key elements such as calculating BMI, identifying weight loss, and applying the MUST scoring system.
• Use accessible training resources. Providing quick-reference materials such as posters, laminated MUST charts, and online guidance allows staff to access support during routine care. E-learning modules are particularly helpful in settings with high turnover because they can be completed flexibly.

How does GLIM compare with MUST in clinical practice?

• The Global Leadership Initiative on Malnutrition (GLIM) criteria and MUST serve different roles and should be used alongside one another rather than interchangeably. MUST is designed to screen patients quickly and identify those at risk of malnutrition, while GLIM is used to diagnose and classify the severity of malnutrition after a patient has screened at high risk. (Cederholm et al. 2025)
• In some cases, applying GLIM may not significantly change the clinical outcome already identified through screening. However, it can provide a more structured way of confirming and staging malnutrition.
• Although GLIM is a valuable framework, there are practical complexities around implementing it in routine clinical settings. For many services, improving the accuracy and consistency of MUST screening remains the immediate priority. While GLIM is important and something healthcare systems should be working towards through commissioning and pathway development, it may take time before it becomes common practice.

Conclusion

In conclusion, accurate nutritional screening is a fundamental step in ensuring that patients at risk of malnutrition receive timely and appropriate care. While tools such as MUST are widely used and well established in clinical practice, their value depends entirely on how accurately they are applied and whether the results lead to clear action.

When screening is inaccurate, incomplete, or not linked to referral pathways, patients who need support may be missed while dietetic services receive inappropriate or delayed referrals. In already overstretched healthcare systems, this can place unnecessary pressure on dietetic teams and reduce the effectiveness of nutritional care.

Improving screening accuracy, strengthening staff training, and ensuring that screening results trigger clear care pathways can help close this gap. By focusing on accurate measurement, correct scoring, and consistent follow-up, healthcare teams can identify malnutrition earlier, prioritise patients most in need of dietetic input, and make better use of valuable clinical resources.

Ultimately, effective screening is not just about completing a tool - it is about ensuring that the right patients receive the right nutritional care at the right time.