The problem with the MUST tool in palliative care
Dorothy House Hospice, like many palliative care providers, was required by its Clinical Commissioning Group (CCG) to screen all its patients and assess their nutritional needs.
The Malnutrition Universal Screening Tool (MUST) was introduced to the hospice but its aims and method of screening were felt by hospice nurses to be inappropriate for some palliative care patients, especially at the end of life. Their views were backed up by the findings of a staff questionnaire undertaken by the hospice.
A Practice Development approach
A multi-disciplinary group was set to develop a patient-centred Practice Development approach to look holistically at nutritional care across the hospice. The group consisted of patients, carers, nurses kitchen staff and volunteers. The initiative received financial and practical support from the Foundation of Nursing Studies.
It was decided that all palliative care patients are potentially at risk of malnutrition and so assessment was more appropriate for them than screening. Listening to patients and carers, it was found that few patients felt their nutritional needs had been thoroughly assessed during the stages of their condition. Carers described their anxiety about the patient’s nutrition and said they needed advice and support.
PLANC- the assessment tool
The available assessment tools were reviewed in the light of the needs expressed by our patients, carers and staff. The group based their work on the Abridged Patient-Generated Subjective Global Assessment (PG-SGA) tool and its two algorithms, one for the early palliative care stage and one for the late palliative care stage. It recognised that whilst the aim of nutritional care is always the promotion of good quality of life, the care may differ as the patient’s condition changes.
The tool was adapted to form the PLANC tool. It was felt this better fitted the expressed needs of patients and the hospice team, it included an assessment of carers’ needs and the algorithms were adapted to meet local guidance and to form the care plans now in use across the hospice.
The audit: MUST screening v PLANC assessment
Twenty patients admitted to the patient unit were randomly assigned to have their nutritional needs either screened by MUST or assessed by PLANC. The dietician involved reviewed their care plans and found little difference for patients in the early/ mid palliative care stages.
However, the PLANC assessment enabled staff to have appropriate conversations with carers and better address their needs. Nurses were reluctant to use the MUST tool for patients at the end of life whereas PLANC could still be used and the algorithm enabled staff to focus on appropriate patient-centred goals and the needs of carers.
A CQC report last month endorsed Dorothy Houses approach to nutritional care:’ It stated: “ Hospice staff worked with a dietician to develop an innovative nutrition assessment tool for people receiving palliative and end of life care. This enabled staff to support people at the end of their life to eat and drink what they wanted for as long as they wanted and recognise when the person was no longer well enough to do so. People had access to high quality food and drink, for as long as they were able and wished to.’
Further information about the PLANC assessment tool can be found on the professional resources section of the Dorothy House Hospice website or by contacting jill.souter@dorothyhouse-hospice.org.uk
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