C0200-C0500: Brief Interview for Mental Status (BIMS)

 

Item Rationale

Health-related Quality of Life

• Direct or performance-based testing of cognitive function decreases the chance of incorrect labeling of cognitive ability and improves detection of delirium.

• Cognitively intact residents may appear to be cognitively impaired because of extreme frailty, hearing impairment or lack of interaction.

• Some residents may appear to be more cognitively intact than they actually are.

• If cognitive impairment is incorrectly diagnosed or missed, appropriate communication, worthwhile activities and therapies may not be offered.

• The BIMS is an opportunity to observe residents for signs and symptoms of delirium.

 

 

 

Planning for Care

• Assessment of a resident’s mental state provides a direct understanding of resident function that may:

— enhance future communication and assistance and

— direct nursing interventions to facilitate greater independence such as posting or providing reminders for self-care activities.

• A resident’s performance on cognitive tests can be compared over time.

— An abrupt change in cognitive status may indicate delirium and may be the only indication of a potentially life-threatening illness.

— If performance worsens, then an assessment for delirium and/or depression should be considered, as a decline in mental status may also be associated with a mood disorder.

• Awareness of possible impairment may be important for maintaining a safe environment and providing safe discharge planning.

Steps for Assessment: Basic Interview Instructions for BIMS (C0200-C0500)

1. Refer to Appendix D for a review of basic approaches to effective interviewing techniques.

2. Interview any resident not screened out by Should Brief Interview for Mental Status Be Conducted? (Item C0100).

3. Conduct the interview in a private setting, if possible.

4. Be sure the resident can hear you.

• Residents with hearing impairment should be tested using their usual communication devices/techniques, as applicable.

• Try an external assistive device (headphones or hearing amplifier) if you have any doubt about hearing ability.

• Minimize background noise.

5. Sit so that the resident can see your face. Minimize glare by directing light sources away from the resident’s face.

6. Give an introduction before starting the interview. Suggested language: “I would like to ask you some questions. We ask everyone these same questions. This will help us provide you with better care. Some of the questions may seem very easy, while others may be more difficult.”

7. If the resident expresses concern that you are testing their memory, they may be more comfortable if you reply: “We ask these questions of everyone so we can make sure that our care will meet your needs.”

8. Directly ask the resident each item in C0200 through C0400 at one sitting and in the order provided.

9. If the resident chooses not to answer a particular item, accept their refusal and move on to the next questions. For C0200 through C0400, code refusals as incorrect/no answer or could not recall.

Coding Instructions

See coding instructions for individual items.

 

Coding Tips

• If the interviewer is unable to articulate or pronounce any cognitive interview items clearly, for any reason (e.g., accent or speech impairment), have a different staff member conduct the BIMS.

• Rules for stopping the BIMS before it is complete:

— Stop the interview after completing (C0300C) “Day of the Week” if:

1. all responses up to this point have been nonsensical (i.e., any response that is unrelated, incomprehensible, or incoherent; not informative with respect to the item being rated), OR

2. there has been no verbal or written response to any of the questions up to this point, OR

3. there has been no verbal or written response to some questions up to this point and for all others, the resident has given a nonsensical response.

• If the interview is stopped, do the following:

1. Code (—), dash in C0400A, C0400B, and C0400C.

2. Code 99 in the BIMS Summary Score (C0500), and if the assessment being completed is a stand-alone Part A PPS Discharge, continue to C1310. Signs and Symptoms of Delirium. Otherwise, proceed to step 3.

3. Code 1, yes in C0600, Should the Staff Assessment for Mental Status be Conducted?

4. Complete the Staff Assessment for Mental Status.

• If all responses to C0200, C0300A, C0300B, and C0300C are coded 0 because answers are incorrect, continue interview.

• When staff identify that the resident’s primary method of communication is in written format, the BIMS can be administered in writing. The administration of the BIMS in writing should be limited to only this circumstance.

• See Appendix E for details regarding how to administer the BIMS in writing.

• Code 0 is used to represent three types of responses: incorrect answers (unless the item itself provides an alternative response code), nonsensical responses, and questions the resident chooses not to answer (or “refusals”). Since 0s resulting from these three situations are treated differently when coding the BIMS Summary Score in C0500, the interviewer may find it valuable to track the reason for each 0 response to aid in accurately calculating the summary score.

Examples of Incorrect and Nonsensical Responses

1. Interviewer asks resident to state the year. The resident replies that it is 1935. This answer is incorrect but related to the question.

Coding: This answer is coded 0, incorrect but would NOT be considered a

nonsensical response.

Rationale: The answer is wrong, but it is logical and relates to the question.

2. Interviewer asks resident to state the year. The resident says, “Oh what difference does the

year make when you’re as old as I am?” The interviewer asks the resident to try to name the

year, and the resident shrugs.

Coding: This answer is coded 0, incorrect but would NOT be considered a

nonsensical response.

Rationale: The answer is wrong because refusal is considered a wrong answer, but the

resident’s comment is logical and clearly relates to the question.

3. Interviewer asks the resident to name the day of the week. Resident answers, “Sylvia, she’s my daughter.” The interviewer asks the resident the question again to confirm the resident is not hearing the question incorrectly, and the resident answers with the same response.

Coding: The answer is coded 0, incorrect; the response is illogical and nonsensical.

Rationale: The answer is wrong, and the resident’s comment clearly does not relate to the question: it is nonsensical.

 

DEFINITION

COMPLETE INTERVIEW

The BIMS is considered complete if the resident attempted and provided relevant answers to at least four of the questions included in C0200-C0400C. Relevant answers do not have to be correct but do need to be related to the question that was asked.

NONSENSICAL RESPONSE

Any response that is unrelated, incomprehensible, or incoherent; it is not informative with respect to the item being rated.