Nurses' views and practices regarding use of validated nutrition screening tools

Objective: To explore nurses' views and practices regarding use of the Malnutrition Screening Tool (MST) and the Malnutrition Universal Screening Tool (MUST) in acute hospital wards. Design: The study used a combined methods design with both qualitative and quantitative techniques including focus groups and survey of patient records. Setting: Four medical or surgical wards in three hospitals within a single health service in Melbourne, Victoria, Australia. Subjects: Registered nurses (n=54). Main outcome measures: Audit results and themes from narrative data. Results: The initial screening rate was 25% and 61% on spot audit of two wards using the MUST, with only 4% (2/47) of patients screened in two wards using the MST. Application of screening was limited by priority of other nursing duties, a nurse's skill in use of a tool, and interpretation of patients' weight status. Some nurses applied individual judgment rather than a tool to assess malnutrition risk. After nurse education and support over four months in wards using the MUST, compliance improved to 46% and 70%, Barriers were identified in use of either tool. Conclusions: Implementation of evidence-based screening tools within patient admission procedures does not automatically translate into nursing practice. Nurses' time and nutrition screening knowledge were the main barriers to efficient screening. This suggests a need for induction programs for new staff and increased feedback to nurses regarding screening practice. A nutrition screening team might provide leadership and advocate for such screening practice and enable development of an audit cycle, including regular performance reporting, to increase compliance.