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Nutritional assessment tools for nurses

Since the 1970s studies have shown malnutrition to be commonplace among patients in hospital, yet it is often unrecognised and worsens during hospital stay [1]. This delays recovery, increases the incidence of serious complications and significantly increases treatment costs [2]. It is therefore commendable that nutritional screening tools have been developed to detect those who are malnourished or at risk of malnutrition.

These tools vary in quality from those published in full in peer-reviewed journals to those which appear to be little more than promotional material.

Some assessment tools reviewed

Scanlan et al [3] discuss the development of a tool and action plan by three British nurses. Assessment criteria avoided anthropometric and biochemical data not often available to nurses. While it uses criteria largely accepted as nutritional risk factors, scoring seems to be arbitrary.

The tool has not yet been subjected to reliability or validity testing; an as yet unpublished study has shown that a non-validated nutritional scoring system may fail to detect almost 50% of patients at risk of malnutrition.

Reilley et al [4] developed a simple Nutritional Risk Score (NRS). A team of dieticians applied the tool to 20 patients - each assessed by two dieticians. The performance of the new tool was validated by comparing NRS with dieticians' clinical impressions and with another published risk score. Not the clearest gold standards for validity, but at least there was good inter-observer reliability.

Twelve dieticians then applied the tool to 153 patients within five days of admission to hospital. Though there was a reported high correlation between dietician and nurse, only 19 patients (12%) were assessed by a nurse and only three nurses took part. A claim that this tool has been validated for use by nurses looks a little premature.


A British Association for Parenteral and Enteral Nutrition (BAPEN) working party has published recommendations for the nutritional screening of every patient admitted to hospital [5]. This tool has been developed from consensus opinion from acknowledged experts. It has yet to be subjected to validity testing. It does have the benefit (see box) of being simple - a great strength.

BAPEN recommendations

All patients should be asked the following questions:-
  • Have you unintentionally lost weight recently?
  • Have you been eating less than normal?
  • What is your normal weight?
  • How tall are you?

All patients should be weighed and have their height measured.

Evidence-based nutritional screening

Nurses wishing to use a nutritional screening tool must ensure that the tool is based on evidence rather than rhetoric. If nurses are to spend valuable time applying a nutritional risk tool then the demonstration of improved patient outcome is a must.

Hazel Rolling
Nutrition Nurse Specialist, Luton & Dunstable Hospital


  1. JE Lennard-Jones. A positive approach to nutrition as treatment. Kings Fund Centre, London, 1992.
  2. DBA Silk. Organisation of nutritional support in hospitals. BAPEN, Maidenhead 1994.
  3. F Scanlan, J Dunne, K Toyne. No more cause for neglect. Introducing a nutritional assessment tool and action plan. Professional Nurse 1994 9:382-5.
  4. HM Reilly, JK Manrineau, A Moran, H Kennedy. Nutritional screening - evaluation and implementation of a simple nutrition risk score. Clinical Nutrition 1995 14: 269-73.
  5. JE Lennard-Jones, H Arrowsmith, C Davison et al. Screening by nurses and junior doctors to detect malnutritioon when patients are first assessed in hospital. Clinical Nutrition 1995 14: 336-40.

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