Key priorities for implementation

Key clinical priorities

  • Screening for malnutrition and the risk of malnutrition should be carried out by healthcare professionals with appropriate skills and training.

  • All hospital inpatients on admission and all outpatients at their first clinic appointment should be screened. Screening should be repeated weekly for inpatients and when there is clinical concern for outpatients. People in care homes should be screened on admission and when there is clinical concern.

  • Hospital departments who identify groups of patients with low risk of malnutrition may opt out of screening these groups. Opt-out decisions should follow an explicit process via the local clinical governance structure involving experts in nutrition support.

  • Nutrition support should be considered in people who are malnourished, as defined by any of the following:

    • a body mass index (BMI) of less than 18.5 kg/m2

    • unintentional weight loss greater than 10% within the last 3 to 6 months

    • a BMI of less than 20 kg/m2 and unintentional weight loss greater than 5% within the last 3 to 6 months.

  • Nutrition support should be considered in people at risk of malnutrition, defined as those who have:

    • eaten little or nothing for more than 5 days and/or are likely to eat little or nothing for 5 days or longer

    • a poor absorptive capacity and/or high nutrient losses and/or increased nutritional needs from causes such as catabolism.

  • Healthcare professionals should consider using oral, enteral or parenteral nutrition support, alone or in combination, for people who are either malnourished or at risk of malnutrition, as defined above. Potential swallowing problems should be taken into account.

Key organisational priorities

  • All healthcare professionals who are directly involved in patient care should receive education and training, relevant to their post, on the importance of providing adequate nutrition.

  • Healthcare professionals should ensure that all people who need nutrition support receive coordinated care from a multidisciplinary team. The composition of this team may differ according to setting and local arrangements.

  • All acute hospital trusts should employ at least 1 specialist nutrition support nurse.

  • All hospital trusts should have a nutrition steering committee working within the clinical governance framework.