The aim of the present audit was to review the use of the recently introduced Malnutrition Universal Screening Tool (MUST) within a hospice inpatient unit (IPU) setting.

Method We reviewed 57 records of patients who were admitted in the hospice IPU in November and December 2022. We looked at the MUST tool screening records which are part of the holistic nursing assessment.

Results 96% of patients were screened using the MUST tool. 90% of them scored as being at medium (9%) or high (81%) risk. Most of the patients (3 in 4) had had significant weight loss in the previous 3–6 months, although only 10% of them were underweight. Most patients’ weight and height were estimated, hence the findings are an approximate.

Discussion This audit gives a snapshot of patients‘ estimated weight, BMI and MUST score. We have shown that, as expected, almost all patients were at risk of malnutrition. For that reason, our conclusion is that the MUST tool is irrelevant in a hospice setting. Malnutrition affects palliative care patients, due to various acute and chronic disease processes, with its prevalence increasing as the terminal phase approaches. If almost all palliative care patients are at risk of malnutrition, then what’s the point of screening for it?

In this audit, most patients were not underweight, although they had experienced significant weight loss in the previous 3–6 months. This finding represents a big shift from the past, where the majority of palliative care patients were underweight. As most adults in the UK are nowadays overweight/obese, they can present at the end of their life with a normal body weight. The authors would like to propose an alternative approach to malnutrition screening, which involves nutritional assessment for symptoms that are associated with impaired nutrition intake and absorption, with an aim to provide symptom relief and perhaps improved nutritional status.