Establishing the role of GNC CAPAC TACP OTs in Assessment, monitoring and reporting of cognitive deficits A quality improvement project. Prepared by Tim Wroot (Occupational Therapist). July 2014

Purpose of todays presentation Sharing good news Demonstrate CAPAC TACP OT role Provide assurance of quality

Back to basics: What is Cognition? BRIEFLY: –Mental abilities and functions –neurological synapses, current experience and past memories –a complex, invisible, multifactorial, cerebral process.

Cognitive assessments undertaken by CAPAC OTs Standardised screening tools Non standardised screening tools Functional assessments Reporting and recommendations.

Rationale for Quality improvement. Prevalence and timely access to help O.T. role poorly understood. Multidisciplinary implications Varied clinical experience and treatment. No standardised approach Differences in service provision

Project Aims Evaluate / validate cognitive screens Clinical competence in cognitive screening. Informing the multidisciplinary team Equitable service provision Documentation to support other clinical roles

Achieving the aims

Aim 1: Evaluate and standardise cognitive screens Team effort Common screening tools examined Version control applied Evaluated against criteria Fit for purpose assessments chosen

The reliability of screening tools Is reliability the best description? One client…..3 screens undertaken MMSE 27/30 (90%) cut off 24 (80%) ACE /100 (85%) cut off 89 (89%) MOCA 21/30 (70%). Cut off point 26 (86%) screens are indicators, not definers.

The OT cognitive screening tool kit Standard toolkit MMSE, Clock Drawing Test, ACE 111, Australian format) Standard toolkit to fit MDT pathways Other assessments might be included Traditional functional assessments

Why use the ACE 111? Ongoing development. Neuropsychology input. Recommended by leading organisations. Well validated. Time efficient Clear instructions Free validated training. More sensitive than MMSE

Aim 2: Clinical competence in assessments Professional duty and ethics Universal competency training Training recognised as correct standard

Aim 3: Informing the multidisciplinary team Multidisciplinary approach Reporting templates suit end user Positive initial results.

OT cognitive screening report Standardised “WORD” template Valid information for GP or Geriatricians Performance against expected norms Strengths and weaknesses Functional abilities in ADLs Carer/relatives and clients perspective Recommendations Ongoing development Copies available

Aim 4: Equality of service provision in cognitive work Agreed screening tools Agreed competency levels Equal access for all clients Equal access to further support

Aim 5: To lead to in-service training Validated competency for OTs Informing for the MDT

Process map for O.T. cognitive screening.

Applications to TACP Clients with cognitive issues Accurate, age appropriate assessments Access to timely psychiatric review A multidisciplinary team approach Retaining clients in their own homes

Case Study Illustrative case study Gentleman of 84 Vascular risks, diabetes Cerebral tumour, VP shunt. Poor memory, variable confusion ACE-111 score 69/100 Verbal fluency significant.

Case Study Initial improvements. Sudden decline Mini craniotomies Re screened Memory strategies applied. Rescreened at end of cognitive intervention. ACE-111 advantages.

Where are we now? Agreed the role of CAPAC OTs Agreed screening toolkit Quality assured training Cognitive pathway and reporting Reduced inequality Approvals received Compliments multidisciplinary team

Acknowledgements Tim Wroot Project Lead The entire Occupational Therapy team The CAPAC Aged Care Education Group Nicole Murdoch (IT saviour) NHS Scotland and University of Glasgow Our clients and their carers

References Alzheimers Society, College of Psychiatrists and U.K. Dept of Health (2012). Helping you to assess cognition. A practical toolkit for clinicians. Dubois, B., Slachevsky, A., Litvan, I., & Pillon, B. (2000). The FAB: a Frontal Assessment Battery at bedside. Neurology, 57(3), AAN Enterprises. Retrieved from Dubois B, Slachevsky A, Litvan I, Pillon B. The FAB: a Frontal Assessment Battery at bedside. Neurology Dec 12;55(11): Grieve, J. Gnanasekaren, L (2008) Neuropsychology for Occupational Therapists 3 rd edition, Oxford: Blackwell Publishing. National Ageing Research Institute. (2011) The assessment of older people with dementia and depression from culturally and linguistically diverse background. A review of current practices and development of guidelines for Victorian Aged Care Assessment Services. Sourced via internet on 25/02/13. NeuraAustralia Frequently asked questions about the ACE Accessed January KICA Instruction Booklet (2006) Kimberley Indigenous Cognitive Assessment (2004) Nasreddine, Z. (MOCA Test Author and copyright owner). Various articles related to the MOCA and alternative versions, published at on 13/02/ Vertesi et al (2001) Canadian Family Physician. Standardised Mini-Mental State Examination, use and interpretation. Zoltan, B. (2007) Vision, Perception and Cognition: A Manual for the evaluation and treatment of the adult with acquired brain injury.

Any questions?