C0300: Temporal Orientation (Orientation to Year, Month, and Day)

 

 

 

Item Rationale

Health-related Quality of Life

• A lack of temporal orientation may lead to decreased communication or participation in activities.

• Not being oriented may be frustrating or frightening.

Planning for Care

• If staff know that a resident has a problem with orientation, they can provide reorientation aids and verbal reminders that may reduce anxiety and encourage resident participation in activities.

• Reorienting those who are disoriented or at risk of disorientation may be useful in treating symptoms of delirium and cognitive problems associated with other medical conditions.

• Residents who are not oriented may need further assessment for delirium, especially if this fluctuates or is recent in onset.

Steps for Assessment

Basic BIMS interview instructions are shown on pages C-4 and C-5.

1. Ask the resident each of the three questions in Item C0300 separately.

2. Allow the resident up to 30 seconds for each answer and do not provide clues.

3. If the resident specifically asks for clues (e.g., “Is it bingo day?”) respond by saying, “I need to know if you can answer this question without any help from me.”

Coding Instructions for C0300A, Able to Report Correct Year

• Code 0, missed by >5 years or no answer: if the resident’s answer is incorrect and is greater than 5 years from the current year or the resident chooses not to respond or the answer is nonsensical.

• Code 1, missed by 2-5 years: if the resident’s answer is incorrect and is within 2 to 5 years from the current year.

• Code 2, missed by 1 year: if the resident’s answer is incorrect and is within one year from the current year.

• Code 3, correct: if the resident states the correct year.

Examples

1. The date of interview is May 5, 2023. The resident, responding to the statement, “Please tell me what year it is right now,” states that it is 2023.

Coding: C0300A would be coded 3, correct.

Rationale: 2023 is the current year at the time of this interview.

2. The date of interview is June 16, 2023. The resident, responding to the statement, “Please tell me what year it is right now,” states that it is 2020.

Coding: C0300A would be coded 1, missed by 2-5 years.

Rationale: 2020 is within 2 to 5 years of 2023.

3. The date of interview is January 10, 2023. The resident, responding to the statement, “Please tell me what year it is right now,” states that it is 1923.

Coding: C0300A would be coded 0, missed by more than 5 years.

Rationale: Even though the ’23 part of the year would be correct, 1923 is more than 5 years from 2023.

4. The date of interview is April 1, 2023. The resident, responding to the statement, “Please tell me what year it is right now,” states that it is “’23”. The interviewer asks, “Can you tell me the full year?” The resident still responds “’23,” and the interviewer asks again, “Can you tell me the full year, for example, nineteen-eighty-two.” The resident states, “2023.”

Coding: C0300A would be coded 3, correct.

Rationale: Even though ’23 is partially correct, the only correct answer is the exact year. The resident must state “2023,” not “’23” or “1823” or “1923.”

Coding Instructions for C0300B, Able to Report Correct Month

Count the current day as day 1 when determining whether the response was accurate within 5 days or missed by 6 days to 1 month.

• Code 0, missed by >1 month or no answer: if the resident’s answer is incorrect by more than 1 month or if the resident chooses not to answer the item or the answer is nonsensical.

• Code 1, missed by 6 days to 1 month: if the resident’s answer is accurate within 6 days to 1 month.

• Code 2, accurate within 5 days: if the resident’s answer is accurate within 5 days, count current date as day 1.

Coding Tips

• In most instances, it will be immediately obvious which code to select. In some cases, you may need to write the resident’s response in the margin and go back later to count days if you are unsure whether the date given is within 5 days.

Examples

1. The date of interview is June 25, 2023. The resident, responding to the question, “What month are we in right now?” states that it is June.

Coding: C0300B would be coded 2, accurate within 5 days.

Rationale: The resident correctly stated the month.

2. The date of interview is June 28, 2023. The resident, responding to the question, “What month are we in right now?” states that it is July.

Coding: C0300B would be coded 2, accurate within 5 days.

Rationale: The resident correctly stated the month within 5 days, even though the correct month is June. June 28th (day 1) + 4 more days is July 2nd, so July is within 5 days of the interview.

3. The date of interview is June 25, 2023. The resident, responding to the question, “What month are we in right now?” states that it is July.

Coding: C0300B would be coded 1, missed by 6 days to 1 month.

Rationale: The resident missed the correct month by six days. June 25th (day 1) + 5 more days = June 30th. Therefore, the resident’s answer is incorrect within 6 days to 1 month.

4. The date of interview is June 30, 2023. The resident, responding to the question, “What month are we in right now?” states that it is August.

Coding: C0300B would be coded 0, missed by more than 1 month.

Rationale: The resident missed the month by more than 1 month.

Coding Instructions for C0300C. Able to Report Correct Day of the Week

• Code 0, incorrect, or no answer: if the answer is incorrect or the resident chooses not to answer the item or the answer is nonsensical.

• Code 1, correct: if the answer is correct.

Examples

1. The day of interview is Monday, June 27, 2023. The interviewer asks: “What day of the week is it today?” The resident responds, “It’s Monday.”

Coding: C0300C would be coded 1, correct.

Rationale: The resident correctly stated the day of the week.

2. The day of interview is Monday, June 27, 2023. The resident, responding to the question, “What day of the week is it today?” states, “Tuesday.”

Coding: C0300C would be coded 0, incorrect.

Rationale: The resident incorrectly stated the day of the week.

3. The day of interview is Monday, June 27, 2023. The resident, responding to the question, “What day of the week is it today?” states, “Today is a good day.”

Coding: C0300C would be coded 0, incorrect.

Rationale: The resident did not answer the question correctly.

 

DEFINITION

TEMPORAL ORIENTATION

In general, the ability to place oneself in correct time. For the BIMS, it is the ability to indicate the correct date in current surroundings.