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Food First Assessment

Food First Assessment

Before initiating a patient on sip feeds they should be screened using the 'Malnutrition Universal Screening Tool' (see below) to ensure that they receive the appropriate therapy.

The assessment can be made by the patients' GP,  nurse (e.g. practice nurse, district nurse, community matron, etc) or Medicines Management Technician/Pharmacist.

For training on the Food First Guidelines please contact the dietetics department.


The Malnutrition Universal Screening Tool 'MUST'

The Malnutrition Universal Screening Tool 'MUST' is a simple validated screening tool to identify adults who are malnourished, at risk of malnutrition (undernutrition) or obese.

The tool has been developed by the Malnutrition Advisory Group of BAPEN (The British Association for Parenteral and Enteral Nutrition). 

It is called the Malnutrition Universal screening Tool 'MUST' to indicate it can be applied to all types of adult patients in all care settings including hospital wards, outpatient clinics, general practice, the community and care homes to facilitate continuity of care. 

The local management guidelines are an important part of the tool and should be used to form part of your care plan. 

MUST Tool.bmp

LOW Risk Patients

No action is needed with this group of patients but continue to monitor their weight for 3 months and re-assess if necessary.

MEDIUM Risk Patients

For this group of patients the Nutritional Support Flow Chart that is contained within the Food First Guidelines should be followed. 

Any barriers to the patient eating normally (e.g. ill fitting dentures, arthritis, unable to shop/cook for themselves) should be identified and resolved. If this does not resolve the problem or the patient just has a poor appetite then food boosting advice (see Food Boosters Patient Information Leaflet below) should be given in the first instance and the patient reviewed after 4 weeks.  

If after this time there has been an improvement in the patients condition, continue to treat in this manner and monitor every 4 weeks for a minimum of 3 months. 

If after the initial 4 week period there is no improvement or there is a deterioration in the patients' condition then they should be treated with sip feeds (1 twice a day) and continue to be monitored on a 4 weekly basis. If there is still no improvement after 3 months then refer to the dietitians stating what measures have already been tried. 

HIGH Risk Patients

This group of patients must be referred to the dietetic service using their referral form (see below for a copy of this). The referral form must be filled out fully including relevant information about the patients health; their current BMI and weight loss and also that they have already been assessed by Food First and that they are a high risk patient. Failure to include all of these details can result in the referral form being sent back and a delay in the patients treatment.  

For More detailed information, see the Care Pathway on page 10 of the Guidelines Booklet. 

NB Sip feeds are only to be used as a supplement to boost calorie intake on a short term basis and must not be used as a long term solution or as a substitute to eating. Please see information on Food Fortification - click here

While you should have copies of the Dietetic Referral Form in the practice, there is a copy below should you need to use it.