7‐MinuteMedi‐Cog

KatherineAnderson,PharmD,CGP,FASCPPharmacistsInternationalConsultingSpecialists

lightdancingonleaves@harding.edu

Professional Resources & Business Development

LearningObjectives

• Articulatethevalueofabriefcognitive/pillboxskillsscreentoidentifypatientsatriskformedicationmisadventures.

• Administerandscoreabriefcognitivescreenthatidentifiesclinicallysignificantcognitiveimpairment.

• Administerapillboxskillsscreendesignedtoidentifypatientswhowouldbenefitfrompillboxeducation.

• Applyclinicaljudgmenttotheinterpretationofapatient’sperformanceontheMedi‐Cog.

• EvaluatetheMedi‐Cogforapplicabilityinvariouspracticesettings.

Self‐AssessmentQuestions

1.HowmanypointsareawardedtoaClockDrawTest(CDT)intheMini‐Cog©scoringrubric?

A.0point

B.1point

C.2points

D.EitherAorC

Self‐AssessmentQuestions

2.IntheMini‐Cog©scoringrubric,howmanypointsareawardedforthecorrectrecallofthreewordsintheThreeItemRecall(TIR)?

A.1point

B.2points

C.3points

Self‐AssessmentQuestions

3.TheMedi‐Cogiscomprisedofwhichofthefollowingscreens?

A.ClockDrawTest(CDT)B.ThreeItemRecall(TIR)C.MedicationTransferScreen(MTS)D.Alloftheabove

Self‐AssessmentQuestions

4.Whichofthefollowingscreenshavebeenvalidated?Whichscreenisapartofthepublicdomain?

A.Medi‐Cog/Mini‐Cog

B.Mini‐Cog/MedicationTransferScreen

C.Mini‐Cog/Medi‐Cog

D.MedicationTransferScreen/Medi‐Cog

Self‐AssessmentQuestions

5.Apatientscores1of5pointsontheMedicationTransferScreen(MTS).Otherthancognitiveimpairment,selectareasonwhythepatientmayhavefailedthescreen.

A.Thepatientwastiredwhenhewasscreened.B.Thepatientisunabletoread.C.Thepatienthadneverdoneatasklikethisbeforeanddidn’tunderstandtheinstructions.D.Thepatientwasnotwearinghisglasses.E.Alloftheabove

MedSafetyScreeningStrategyNeededfor77Boomers+

• Medicationerrorsinjureover1.5millionpeopleayear.1

• Regimennon‐adherenceisassociatedwithinjury,higherhealthcareexpenditures,lossofqualityoflife.

• Healthoutcomeshavebeenshowntoimproveformanypatientswhoutilizeapillbox.2

• Ourgoal:useproactivepreventionstrategies.• Implementswiftandaccuratewaystoidentifypatientsatriskformedicationmismanagement.

1.http//www8nationalacademies.org/onpinews/newsitem.aspx?RecordID+11623.Accessed3/1/20102.ZelikovskyN,etal.Perceivedbarrierstoadherenceamongadolescentrenaltransplantcandidates.PediatrTransplant.2008May;12(3):300‐8.

SafeMedicationManagement

• Limitedvalidatedscreenstopredictmedadherence.• Mini‐Cog©isvalidatedasacognitivescreen.• Medi‐Coghasnotyetbeenvalidated.(Mini‐Cog©+MTS)

• MedicationTransferScreen(MTS)wasdevelopedintheVAandispublicdomain.Ithasnotbeenvalidated.

• Medi‐Cogdevelopedasabriefassessmentofcognition,literacy,pillboxskillsto:– Identifypatientswhohavecognitivedeficit– Alertforliteracydeficits– Flagpatientswhowouldbenefitfrompillboxeducation

1010

Mini‐CogMini‐Cog©©MethodMethod

• Threeitemrecall(TIR)‐screenernames3unrelatedobjects(banana/sunrise/chair);patientrepeatsthemback.Patientistoldtheywillbeaskedtorecallthewordsintwominutes.

• Clockdrawingtest(CDT)‐subjectisaskedtodrawthefaceofaclock,thentodrawthehandsoftheclockdepicting11:10.“Tenminutesaftereleven.”

• AfterperformingtheCDT,thesubjectisaskedtorecallthe3words.

Borsonetal.JAmGeriatrSoc2005;53:871‐4.

1111

Mini‐CogMini‐Cog©©ScoringScoring

• Mini‐Cog©–5points– ThreeItemRecall(TIR)‐1pointforeachitemrecalled(0‐3possible)

– ClockDrawTask‐2pointsforacorrectclock;ifallnumbersarenotpresent,ornotincorrectsequenceorposition,thescoreiszero

• Passingscore:>3– All3wordsofTIROR

– Correctclockandrecallofatleastoneword

Mini‐Cog©Administration&Scoring

AudienceParticipation

MedicationTransferScreen• Onthetablewritethenumberofpillsas

instructedintothecorrectcompartments:

• Example:TAKEONETABLETEVERYDAYATBEDTIME(Patientfillsinremainingslots).

• 1.TAKEONETABLETEVERYDAYINTHEMORNING

• 2.TAKEONETABLET3TIMESDAILYWITHMEALS

• 3.TAKETWOTABLETSM‐W‐FINTHEEVENING

• 4.TAKEONE‐HALFTABLETONSATURDAYATBEDTIME

• 5.HowmanypillstotalareinthepillboxfortheentiredayofSaturday?__

S M T W Th F S

Morn

Noon

Eve

Bed 1 1 1 1 1* 1* 1*

Score:1pointforeachMTSquestion(0to5points)

Reprinted with permission of the American Society of Consultant Pharmacists, Alexandria, Virginia, www.ascp.com. All rights reserved.

Reprinted with permission of the American Society of Consultant Pharmacists, Alexandria, Virginia, www.ascp.com. All rights reserved.

MedicationTransfer(MTS)Administration&Scoring

AudienceParticipation

Medi‐Cog

• StudyresultsdemonstratedthatMedi‐Cogscreenscorescorrelated0.72withpatientaccuracyinloadingmedicationsinapillbox.

• Screenutilizedinvariouspracticesettings– Attimeofdischargefromhospitals,LTC,SNF.– ALFadmitandroutinescreenforselfadministeredmeds.

– Communitypharmacy– Seniorcentersscreenings

• AndersonK,JueSG,Madaras‐KellyKJ.IdentifyingPatientsatRiskforMedicationMismanagement:UsingCognitiveScreenstoPredictaPatient’sAccuracyinFillingaPillbox.ConsultPharm2008;June;23(6):259‐72.

Self‐AssessmentQuestions

1.HowmanypointsareawardedtoaClockDrawTest(CDT)intheMini‐Cog©scoringrubric?

A.0point

B.1point

C.2points

D.EitherAorC

Self‐AssessmentQuestions

1.HowmanypointsareawardedtoaClockDrawTest(CDT)intheMini‐Cog©scoringrubric?

A.0point

B.1point

C.2points

D.EitherAorC

Self‐AssessmentQuestions

2.IntheMini‐Cog©scoringrubric,howmanypointsareawardedforthecorrectrecallofthreewordsintheThreeItemRecall(TIR)?

A.1point

B.2points

C.3points

Self‐AssessmentQuestions

2.IntheMini‐Cog©scoringrubric,howmanypointsareawardedforthecorrectrecallofthreewordsintheThreeItemRecall(TIR)?

A.1point

B.2points

C.3points

Self‐AssessmentQuestions

3.TheMedi‐Cogiscomprisedofwhichofthefollowingscreens?

A.ClockDrawTest(CDT)B.ThreeItemRecall(TIR)C.MedicationTransferScreen(MTS)D.Alloftheabove

Self‐AssessmentQuestions

3.TheMedi‐Cogiscomprisedofwhichofthefollowingscreens?

A.ClockDrawTest(CDT)B.ThreeItemRecall(TIR)C.MedicationTransferScreen(MTS)D.Alloftheabove

Self‐AssessmentQuestions

4.Whichofthefollowingscreenshavebeenvalidated?Whichscreenisapartofthepublicdomain?

A.Medi‐Cog/Mini‐Cog

B.Mini‐Cog/MedicationTransferScreen

C.Mini‐Cog/Medi‐Cog

D.MedicationTransferScreen/Medi‐Cog

Self‐AssessmentQuestions

4.Whichofthefollowingscreenshavebeenvalidated?Whichscreenisapartofthepublicdomain?

A.Medi‐Cog/Mini‐Cog

B.Mini‐Cog/MedicationTransferScreen

C.Mini‐Cog/Medi‐Cog

D.MedicationTransferScreen/Medi‐Cog

Self‐AssessmentQuestions

5.Apatientscores1of5pointsontheMedicationTransferScreen(MTS).Otherthancognitiveimpairment,selectareasonwhythepatientmayhavefailedthescreen.

A.Thepatientwastiredwhenhewasscreened.B.Thepatientisunabletoread.C.Thepatienthadneverdoneatasklikethisbeforeanddidn’tunderstandtheinstructions.D.Thepatientwasnotwearinghisglasses.E.Alloftheabove

Self‐AssessmentQuestions

5.Apatientscores1of5pointsontheMedicationTransferScreen(MTS).Otherthancognitiveimpairment,selectareasonwhythepatientmayhavefailedthescreen.

A.Thepatientwastiredwhenhewasscreened.B.Thepatientisunabletoread.C.Thepatienthadneverdoneatasklikethisbeforeanddidn’tunderstandtheinstructions.D.Thepatientwasnotwearinghisglasses.E.Alloftheabove