Committee Group Updates


have used them to promote the importance of recognising malnutrition, especially in the community.


NSW has identified some areas of nutritional care that need attention. Following our presentations at last year’s BAPEN Conference, two papers have been accepted for publication in the Proceedings of the Nutrition Society. One provides a summary of some of the key findings and implications of the NSW initiative and the other indicates the need for government to establish a valid database on the prevalence of malnutrition (instead of relying on grossly inadequate databases) to monitor the changes over time and the effects of interventions.


MALNUTRITION ACTION GROUP (MAG)


Malnutrition Advisory Group (now called the Malnutrition Action Group) developed the ‘Malnutrition Universal Screening Tool’ (‘MUST’) framework of nutritional care, although most of the validation work has been undertaken outside BAPEN (by individuals who are also members of MAG). MAG remains focused in its efforts to embed the ‘MUST’ framework in routine clinical practice in the UK. Specific activities, which are expected to extend into the next period, are listed below:


1. Services


(i) Information service: With the help of Kirstine Farrer, who was appointed last year, we continue to respond to regular queries about nutritional screening and care and particularly about the ‘MUST’ framework. In addition to queries from UK, there is a steady stream of queries from other countries.


(ii) Reviewing and ‘approving’ the ‘MUST’ framework for trusts: Before implementing the ‘MUST’ framework, trusts have been requesting approval of their policies and procedures from BAPEN (MAG). We have frequently refused to accept modifications to essential components of ‘MUST’ to ensure that a consistent framework remains. Requests to approve components of the framework that are associated with local policies and resources are generally accepted.


(iii) Licence to use ‘MUST’: In addition to approving the use of ‘MUST ‘we also approve and grant a licence for the use of ‘MUST’ in materials designed for commercial purposes. About 10 have been granted so far, and this generates an income for BAPEN.


2. Education and training: e-learning modules on the ‘MUST’ framework


After a multitude of requests from various trusts in the UK for MAG to approve educational packages involving ‘MUST’, it was felt that MAG should be actively involved in producing its own e-learning modules on the ‘MUST’ framework, especially since the Core Learning Unit in the DH had not developed a module on nutritional screening. A collaboration between BAPEN and the Greater Glasgow and Clyde NHS Trust was set up to produce an interactive e-learning module


for hospital workers. This has been available for several months and is in need of active promotion, since many trusts within the UK are unaware of its existence. To aid promotion, additional information has been added to the BAPEN website as well as a separate item (see page 5) in this issue of In Touch. The e-learning module has a facility to track and certify individuals who have completed the module. This feature should be attractive to trusts that are seeking to implement educational and training policies on nutritional screening. It also allows trusts to provide evidence of education and training, which may be required by regulatory agencies such as the Care Quality Commission (CQC). The community module is in the final stages of completion. It has been sent to the BAPEN education and training committee for review, and it is in the process of being field tested by a series of community workers. Later we plan to seek comments and support from BAPEN Council and other organisations (e.g. RCN, BDA) and the Core Learning Unit of the DH. The new module will also require active promotion.


3. Review of ‘MUST’ framework


(i) Guidelines: A review and approval of guidelines on nutritional screening (Summarising clinical guidelines for primary care; available in hard copy and electronically – www.eguidelines.co.uk) are made three or four times a year.


(ii) The ‘MUST’ framework: This is reviewed intermittently.


4. Developing more flexible options for ‘MUST’ material


(i) New charts: The presentation of charts, tables, and wording on some of the documents (including the range of weight, height and BMI values on the charts) are currently being reviewed with the aim to develop charts and other material in alternative formats.


(ii) ‘e-MUST’ calculations: A number of different electronic versions of ‘MUST’ have been developed and some used by staff and patients over the last few years. From the time of the first series of clinical trials, undertaken about two or three years ago at Southampton in both patients (self screening using an electronic version of ‘MUST’ ) and staff (comparison of paper with ‘e-MUST’ versions of ‘MUST’), it was felt was that there was potential for further development of ‘e-MUST’ for incorporation into computers, hand held instruments, telephones, and other types of electronic devices, some of which could be used to transmit data, as well as the BAPEN website. It is anticipated that some ‘e-MUST’ results from the early clinical studies will be presented at the BAPEN conference in November. Members of MAG have advised the DH (Connecting for Health) on the inclusion of ‘e-MUST’ into the Lorenzo software, as part of National Programme for IT, which is now available for use in the NHS. Various members of MAG have become aware that electronic versions of ‘MUST’ or its components have been developed independently of BAPEN and can be found on other websites e.g. in Wales,


Bradford, London. Some of them do not yield correct results and we feel that the presentation of ‘MUST’ on some websites is not particularly attractive. For obvious reasons, members of MAG feel that any BAPEN developments related to ‘MUST’ should be co-ordinated and channelled through MAG. Various options for developing and launching ‘MUST’ calculators have been explored, and considered at the BAPEN Think Tank meeting in June 2010.


5. Malnutrition coding systems in primary care


To facilitate recognition of malnutrition in the community as well as continuity of care between settings, it is necessary to use consistent criteria and coding systems. At least two coding issues have become incorporated into the MAG strategy for the next period: to try to incorporate ‘MUST’ categories into the SNOMED-CT coding system (Systematized Nomenclature of Medicine - Clinical Terms), a process that may require clinical lobbying to influence Connecting for Health (DH); and (if the first step is successful) promotion of the SNOMED codes for ‘MUST’. The existence for ‘MUST’ is already acknowledged in at least two of the four software systems commonly used in primary care, but there are plans to configure these using SNOMED. Marinos Elia has been corresponding with DH/CSC (Computer Science Corporation) officials to better understand the process that is necessary to implement the change. On the advice of the Clinical Terminology Director, CSC Alliance (which is responsible for the delivery of the NHS National Programme for IT across large parts of England), MAG plans to request new SNOMED terms from the UK Terminology Centre. There is some support for this among officials involved in the NHS National Programme for IT, although there is a general policy to resist adding new terms to SNOMED.


Impact of ‘MUST’


‘MUST’ is now the most commonly used nutrition screening tool in the UK, both in hospitals and the in the community. It is widely supported by governmental and non- governmental organisations, and it has been incorporated into various policy documents by the governments of the four devolved nations. With the CQC in England expecting evidence of appropriate nutritional care from October 2010, there is now an opportunity, and a greater need than previously to embed nutritional screening in routine clinical care. The MAG strategy is to make the ‘MUST’ framework more flexible and accessible. It also aims to ensure that screening is done more quickly, and more effectively, and without misconceptions. Since its launch in 2003, ‘MUST’ has generated a significant income for BAPEN through sales of the ‘MUST’ Report and ‘MUST’ resources.


BAPEN In Touch No.58 August 2010 12


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