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Preventing and Managing
Malnutrition and Dehydration
A guide for your care home
Introduction
Nutrition and hydration (Food and fluids) are everyone’s responsibility, staff,
family and residents themselves. The consequences of not providing sufficient
food or fluid are serious, including fragile skin, increased risk of infections
such as pneumonia and acute kidney injury due to dehydration.
These resources are designed to assist in the identification and on going
management of malnutrition and ensuring good hydration in all residents.
Nutrition
In this first section we will learn how to identify and reduce the risk of
malnutrition. We will do this by:
Food Refusal Understand the reasons why
a resident may refuse food See the chart on page 3
and what you can do to help
MUST Screening for Use the MUST Screening Tool
Malnutrition to identify if there is a risk See pages 4-8
of malnutrition
MUST Score Sheet and Record MUST Score monthly
Monthly Record and identify the care plan you See page 9
should follow
The nutritional care plans in
Follow the appropriate care these resources have been
Nutrition Care Plans plan identified from the MUST developed and trialled by
Score Sheet the Rotherham Doncaster
and South Humber Dietetic
Service - page 10
Use your care home food and
Food and Fluid Charts fluid charts to record MUST See page 11
snacks and drinks consumed
Pages 12-14 provide:
Menus, Recipes, Print off and display the Fortified diet menu
Snacks and Drinks supplied menus and recipes to MUST snacks and recipes
help follow the Care Plans
MUST drinks/shots recipes
page 2 Copyright © 2019 Bassetlaw Clinical Commissioning Group
Food Refusal
Sometimes residents may refuse food or fluid for various reasons. Here are
some common reasons and the things you can do to help.
Possible reason for food refusal What you can do
Dislike of food being offered Record residents likes/dislikes
Unfamiliar foods being offered Know cultural /religious requirements
Use visual cues and pictures of food
Sore mouth Promote good oral hygiene –treat infections/
Dentures dental checks
Problems swallowing Refer to SALT if swallowing problems
Physical problem Provide appropriate adaptive cutlery or give
assistance at meal times
Unaware of meal times Explain when meal times are, prepare
May simply not wish to eat individual for mealtimes and set regular
daily patterns. Have regular helpers to assist
with feeding if needed
Give finger foods, small regular meals given
throughout day not just at set meal times*
Physical contact - hold hands, eye contact -
may take food from relatives
Depression causing anorexia Treatment with medication/psychiatric
Paranoia (fear of poisoning) assessment
Sealed food containers opened in front of
individual
Inability to feed themselves or open Ensure help is provided when needed
packaging
MUST Screening for Malnutrition
MUST (Malnutrition Universal Screening Tool) is a validated tool to help you
to identify individuals who may be at risk of malnutrition, and who may
benefit from appropriate nutritional intervention.
The full tool comprises of 5 steps and is on page 4-8 of this resource. A
detailed explaination of how to use the MUST screening tool can be found by
watching the nutrition film on the ‘React To Malnutrition and Dehydration,
web page.
page 3 Copyright © 2019 Bassetlaw Clinical Commissioning Group
Step 2 Step 3
Step 1 + +
BMI score Weight loss score Acute disease effect score
Unplanned
BMI kg/m2 Score weight loss in If patient is acutely ill and
>20 (>30 Obese) = 0 past 3-6 months there has been or is likely
18.5-20 = 1 % Score to be no nutritional
<18.5 = 2 <5 = 0 intake for >5 days
5-10 = 1 Score 2
>10 = 2
If unable to obtain height and weight, see Acute disease effect is unlikely to
reverse for alternative measurements and apply outside hospital. See ‘MUST’
use of subjective criteria Explanatory Booklet for further
Step 4 information
Overall risk of malnutrition
Add Scores together to calculate overall risk of malnutrition
Score 0 Low Risk Score 1 Medium Risk Score 2 or more High Risk
Step 5
Management guidelines
0 1 2 or more
Low Risk Medium Risk High Risk
Routine clinical care Observe Treat*
Document dietary intake for Refer to dietitian, Nutritional
Repeat screening 3 days
Hospital – weekly Support Team or implement local
Care Homes – monthly If adequate – little concern and policy
Community – annually repeat screening Set goals, improve and increase
for special groups Hospital – weekly
Care Home – at least monthly overall nutritional intake
e.g. those >75 yrs Monitor and review care plan
Community – at least every
2-3 months Hospital – weekly
If inadequate – clinical concern Care Home – monthly Community
–follow local policy, set goals, –monthly
e 2 improve and increase overall *Unless detrimental or no benefit is
nutritional intake, monitor and expected from nutritional support e.g.
review care plan regularly imminent death.
Scor
All risk categories: All risk categories:
Treat underlying condition and provide help and Obesity:
Treat underlying condition and provide help and
Record presence of obesity. For those with
advice on food choices, eating and drinking when
advice on food choices, eating and drinking when
necessary. underlying conditions, these are generally controlled
Record malnutrition risk category. before the treatment of obesity.
Record malnutrition risk category.
Record need for special diets and follow local policy.
Record need for special diets and follow local policy.
Re-assess subjects identified at risk as they move through care settings
page 4 © BAPEN
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