P59
AUDIT OF INITIAL NUTRITION ASSESSMENT TOOL (i-NAT) USED ON
BUCKLAND RENAL WARD, ST GEORGE’S HOSPITAL
Htun, K
St George’s Hospital, London
PROBLEM & PURPOSE:
This audit examined the sensitivity of a new screening tool labelled i-NAT (Initial Nutritional
Assessment Tool) which was developed by renal dietitians on a renal ward. Based on their
experience in dealing with chronic renal patients, the renal dietitians felt the current screening
tool, MUST (Malnutrition Universal Screening Tool), was not sensitive enough for detecting
malnutrition in renal patients. A comparison was then made between i-NAT and an earlier
MUST audit based on their sensitivity in detecting malnutrition.
DESIGN:
This audit was conducted on the renal ward between 5th and 16th September 2011. Patients
admitted to the ward during that period were assessed using i-NAT. 35 renal patients were
assessed, 18 female and 17 male, with an average age of 60. The youngest patient was 19 and
the oldest was 88. The same patients were also assessed using a more comprehensive tool that
had been designed by the dietitians to identify malnutrition. This was used as the gold standard
for assessing the sensitivity and specificity of i-NAT.
FINDINGS:
The overall sensitivity and false negative rate of i-NAT in detecting malnutrition were 67% and
33% respectively, compared to the figures of 45% and 55% achieved by MUST in an earlier
audit (2009).
CONCLUSION:
MUST only assesses risk based on patients’ BMI, weight loss, and whether the patient is acutely
ill, meaning that it is less sensitive in detecting malnutrition in chronically ill patients. The
current audit shows that i-NAT is more sensitive than MUST for chronic patients because it
records both food intake and also captures target weight.
RELEVANCE:
As a result of this audit i-Nat has now replaced MUST as the malnutrition screening tool of
choice for renal patients on the renal ward. During the course of the audit a number of
improvements were suggested which have also been implemented by the ward. These include
improvements to the structure of i-NAT as well as working methods relating to its use by nurses.