Unplanned weight loss score in past 3-6 months
Acute disease effect score
If patient is acutely ill & there has been or is likely to be no nutritional intake for more than 5 days
Total score 0-6
Routine clinical care
Review/repeat screening monthly in care homes
Annually in community if BMI > 30kg/m2 (obese) treat according to local policy/national guidelines
Routine Clinical Care
Dietary advice to maximise nutritional intake. Record intake for 3 days, encourage small frequent meals and snacks, with high energy and protein food and fluids13.
Powdered nutritional supplements to be made up with water or milk are available13.
Review progress/repeat screening after 1-3 months according to clinical condition or sooner if the condition requires.
If improving continue until 'low risk'.
If deteriorating, consider treating as 'high risk'.
Prescribe oral nutritional supplements (ONS) and monitor.
On improvement, consider managing as ‘medium risk’.
If no improvement or more specialist support is required, refer to dietitian.
* Treat unless detrimental or no benefit is expected from nutritional support.
In most cases malnutrition is a treatable condition that can be managed using first line dietary advice to optimise food intake and oral nutritional supplements (ONS)13.
Management of malnutrition should be linked to the level of malnutrition risk14.
For all individuals: (click on boxes below for information)
Include; details of screening (weight, previous weight, BMI), screening result, risk category or clinical judgement. Record actions taken to manage malnutrition risk.
Set goals to assess the effectiveness of intervention e.g. prevent further weight loss, maintain nutritional status, optimise nutrient intake during acute illness, healing of wounds or pressure ulcers, improved mobility.
Consider disease stage and treatment; adjust goals of intervention accordingly. For example nutritional interventions in some groups such as palliative care, patients undergoing cancer treatment, patients with progressive neurological conditions and those in advanced stages of illness may not result in improvements in nutritional status, but may provide a valuable support to slow decline in weight and function.
Monitor progress against goals and modify intervention appropriately.
Consider weight, strength, physical appearance, appetite, ability to perform activities of daily living compared with goals set.
Frequency of monitoring depends on setting and treatment.
If appropriate treat the underlying cause of malnutrition.
Members of the multidisciplinary team including Dietitians, Occupational Therapists, Speech and Language Therapists, Community Matrons and Community Therapists may need to be involved according to an individual's clinical condition.
Management options can include good food, assistance with eating, addressing social issues, ensuring ability to shop (physical and financial) and prepare food, texture modification, dietary advice to maximise nutritional intake (also known as ‘food first’) and ONS to complement dietary strategies in order to support individuals to meet their nutritional requirements7.
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