Mini-Cog Screening Tool: Early Identification of Patients with Cognitive Impairment
Last updated
Share PrintNursing cognitive screening identifies patients whose cognitive deficits have gone unnoticed or unrecorded in routine clinical encounters. This results in appropriate referrals to provide early diagnosis, differential, and treatment. Early treatment can provide improved patient outcomes by slowing or delaying disease progression which has been shown to improve quality of life for both the patient and their family while allowing additional time for important decisions.
Origin:
July 2019, The Villages VA Clinic
Adoptions:
19 successful
Awards and Recognition:
VHA Shark Tank Winner
Partners:
Diffusion of Excellence, VHA Innovators Network
Recent Updates
Overview
The problem
Several Primary Care Nurses observed a trend in which some of their patients appeared to have cognitive delays but had no evidence of previous interventions, diagnosis, or treatment despite having a screening question reminder prior to provider appointments. The nurses theorized that, given a simple but effective screening tool, nurses could bridge that gap
...
Several Primary Care Nurses observed a trend in which some of their patients appeared to have cognitive delays but had no evidence of previous interventions, diagnosis, or treatment despite having a screening question reminder prior to provider appointments. The nurses theorized that, given a simple but effective screening tool, nurses could bridge that gap and become an integral part of early diagnosis and treatment for these Veterans. A review of literature was performed which suggested that the Mini-Cog was one of the most reliable and accessible tools available for dementia screening. A search of CPRS showed no availability of dementia screening tools or templates.
See more
See more
Files
- How to access and use the new Mini-Cog template in CPRS Mini-Cog template
- Information for providers so to be aware that nurses are performing cognitive screening Cognitive Screening Process for Providers
- Use this implementation guide if you want to adopt this process in your clinical area Mini-Cog Screening Implementation Guide
The solution
The Mini-Cog© is a 3-minute instrument that can increase the detection of cognitive impairment in older adults. It can be used effectively after a brief training in both healthcare and community settings. (Mini-Cog, n.d.)
The goal of screening for cognitive impairment in primary care is to find patients whose cognitive deficits have gone unnoticed or unr ... The Mini-Cog© is a 3-minute instrument that can increase the detection of cognitive impairment in older adults. It can be used effectively after a brief training in both healthcare and community settings. (Mini-Cog, n.d.)
The goal of screening for cognitive impairment in primary care is to find patients whose cognitive deficits have gone unnoticed or unrecorded in routine clinical encounters. Symptoms may be severe enough to interfere with the patient’s self-care and medical management. (Mini-Cog, n.d.).
Nursing implementation of the mini-cog tool provides an easy and consistent process for early recognition of cognitive impairment. This results in appropriate referrals to provide early diagnosis, differential, and treatment. Early treatment can provide improved patient outcomes by slowing or delaying disease progression which has been shown to improve quality of life for both the patient and their family while allowing additional time for important decision making and planning. See more
The goal of screening for cognitive impairment in primary care is to find patients whose cognitive deficits have gone unnoticed or unr ... The Mini-Cog© is a 3-minute instrument that can increase the detection of cognitive impairment in older adults. It can be used effectively after a brief training in both healthcare and community settings. (Mini-Cog, n.d.)
The goal of screening for cognitive impairment in primary care is to find patients whose cognitive deficits have gone unnoticed or unrecorded in routine clinical encounters. Symptoms may be severe enough to interfere with the patient’s self-care and medical management. (Mini-Cog, n.d.).
Nursing implementation of the mini-cog tool provides an easy and consistent process for early recognition of cognitive impairment. This results in appropriate referrals to provide early diagnosis, differential, and treatment. Early treatment can provide improved patient outcomes by slowing or delaying disease progression which has been shown to improve quality of life for both the patient and their family while allowing additional time for important decision making and planning. See more
Videos
Above:
Mini-Cog Screening at The Villages VA Outpatient Clinic
Files
- Poster Presentation Overview Mini-Cog Mini-Cog Poster_FINAL.pdf
- 7.26.21 VA Coverage of Mini-Cog Screening July 26 VA Article on Mini-Cog Screening.docx
- Process that TVOPC nurses utilize to screen Veterans with memory loss Cognitive Screening Process in Primary Care
The results
Currently the mini-cog is documented in the Nurse Procedure Template. However, we have found nurses documenting in other templates and notes. This has made tracking metric data slow and cumbersome. A new template has been developed to assure all documentation will be consistent and easier to track.
Phase 1: A total of 2,366 veterans were seen among the ... Currently the mini-cog is documented in the Nurse Procedure Template. However, we have found nurses documenting in other templates and notes. This has made tracking metric data slow and cumbersome. A new template has been developed to assure all documentation will be consistent and easier to track.
Phase 1: A total of 2,366 veterans were seen among the four provider panels. Of those 104 (4%) were screened. Of that [104] total, 30 (29%) Veteran’s failed; 13 of those Veteran’s were seen by the Neuropsychologist and 8 (27%) were diagnosed with some form of dementia. Phase 2: During the COVID-19 pandemic the project was implemented clinic-wide and 8,338 Veterans were. Of those only 15 (0.1%) Veterans were screened with the Mini-Cog. Out of those 15, 11 (73%) failed the screening. Three (3) of those 11 where assessed by Neuropsychology and all three (27%) were diagnosed with a cognitive deficit. See more
Phase 1: A total of 2,366 veterans were seen among the ... Currently the mini-cog is documented in the Nurse Procedure Template. However, we have found nurses documenting in other templates and notes. This has made tracking metric data slow and cumbersome. A new template has been developed to assure all documentation will be consistent and easier to track.
Phase 1: A total of 2,366 veterans were seen among the four provider panels. Of those 104 (4%) were screened. Of that [104] total, 30 (29%) Veteran’s failed; 13 of those Veteran’s were seen by the Neuropsychologist and 8 (27%) were diagnosed with some form of dementia. Phase 2: During the COVID-19 pandemic the project was implemented clinic-wide and 8,338 Veterans were. Of those only 15 (0.1%) Veterans were screened with the Mini-Cog. Out of those 15, 11 (73%) failed the screening. Three (3) of those 11 where assessed by Neuropsychology and all three (27%) were diagnosed with a cognitive deficit. See more
Metrics
- Phase 1: A total of 2,366 veterans were seen among the four provider panels. Of those 104 (4%) were screened. Of that [104] total, 30 (29%) Veteran’s failed; 13 of those Veteran’s were seen by the Neuropsychologist and 8 (27%) were diagnosed with some form of dementia. Phase 2: During the COVID-19 pandemic the project was implemented clinic-wide and 8,338 Veterans were. Of those only 15 (0.1%) Veterans were screened with the Mini-Cog. Out of those 15, 11 (73%) failed the screening. Three (3) of those 11 where assessed by Neuropsychology and all three (27%) were diagnosed with a cognitive deficit.
Diffusion tracker
Does not include Clinical Resource Hubs (CRH)
Multimedia
Images
Above:
Local Recognition of Process
Above:
VAntage point news
Implementation
Timeline
-
Start
Announcement, collaboration, and buy in from Mental Health, Social workers to complete SLUMs, Neurology or Neuropsychology, primary care providers, and primary care nursing of new process. (Nursing to administer mini-cog> patients failing mini-cog to be referred to SW to perform SLUMS> failure of SLUMS to be referred to PC Provider to consult neurology/neuropsychology for evaluation, diagnosis, and recommendations for treatment) -
60 days
Import and set up CPRS nursing Mini-cog Templates. Obtain approval of Clinical Informatics/Nursing Documentation Committees for implementation. -
90 days
Nursing education to one to two PC teams for 30 days then pilot one to two PC teams for 60 days. Do not go live with templates until education has been provided. Provide part-time Nurse superuser for team support, identification of pilot gaps. Problem solve any pilot gaps. Review metrics. -
150 days
Spread mini-cog process training to all outpatient nursing, outpatient providers, outpatient social workers. Provide separate detailed education/training to nursing for administration of mini-cog, use of CPRS template, and process for educating patients/family. -
180 days
Spread practice to other PACT teams. Continue to monitor metrics.
Departments
- Social work
- Education and training
- Nursing services
- Psychology
- Information technology
- Internal medicine
- Information management
- Primary care
Core Resources
| Resource type | Resource description |
|---|---|
PEOPLE |
|
PROCESSES |
|
TOOLS |
|
Files
- Mini-Cog Hardcopy Mini-Cog Template Hardcopy.pdf
- Mini-Cog documentation and instructions Mini-Cog LIVE - shark tank.pdf
Support Resources
| Resource type | Resource description |
|---|---|
PEOPLE |
|
PROCESSES |
|
Files
- Mini-Cog screening tool Mini-Cog Template Hardcopy.pdf
- Documentation and template instructions Mini-Cog LIVE - shark tank.pdf
About
Origin story
Several Primary Care Nurses observed a trend in which some of their patients appeared to have cognitive delays but had no evidence of previous interventions, diagnosis, or treatment despite having a screening question reminder prior to provider appointments. The nurses theorized that, given a simple but effective screening tool, nurses could bridge that gap
...
Several Primary Care Nurses observed a trend in which some of their patients appeared to have cognitive delays but had no evidence of previous interventions, diagnosis, or treatment despite having a screening question reminder prior to provider appointments. The nurses theorized that, given a simple but effective screening tool, nurses could bridge that gap and become an integral part of early diagnosis and treatment for these Veterans. A review of literature was performed which suggested that the Mini-Cog was one of the most reliable and accessible tools available for dementia screening. A search of CPRS showed no availability of dementia screening tools or templates. A new process was implemented to allow nursing to perform early cognitive screening. This has resulted in improved patient outcomes and quality of life.
Original team
Gladys Y. Fontanez MSN, APRN, FNP-C
Co-Lead
Kasey McBride, BSN, RN
Co-Lead
Jackie Brumbaugh, MSN, RN, CEN, AMB-BC
Co-Lead
Jocelyn Havana Almazan
Lead
Comment
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