268 - Impact of Nurse Scripting on Cognitive Impairment Testing Using the Mini-Cog in Patients Hospitalized for Heart Failure

Abstract

Introduction: Cognitive impairment (CI), as assessed by the Mini-Cog, a simple three-minute word recall and clock draw test, has been shown to be a strong predictor of heart failure (HF) readmissions in patients over the age of 65. In our experience, high patient refusal rates have limited the clinical utility of the Mini-Cog in the inpatient setting. Hypothesis: We hypothesized that standardized nurse scripting in introducing CI screening to patients hospitalized for HF would reduce their rate of refusal to participate in testing. Methods: We collaboratively developed a standardized script for HF nurse navigators (n = 4) to introduce the Mini-Cog to older adults hospitalized for HF at Franciscan Health, a community-based hospital in Indianapolis, Indiana, USA. This involved telling the patient at the end of an inpatient care coordination visit, “I have an activity I would like to complete before I leave. This is something we like to do with our patients 65 and older. Can I proceed?” We then documented whether or not the patient agreed to participate. Results: In the six months prior to nurse scripting, 50 of 216 (23%) older adults hospitalized for HF refused to complete the Mini-Cog. In the six months after implementation, 19 of 209 (9%) patients refused to complete testing (Z-score 3.9, P < .001) (Fig. 1). Conclusions: A large proportion of older adults hospitalized for HF are hesitant to participate in CI screening as part of care coordination pre-discharge assessment. A standardized script used by nurse navigators to introduce testing is effective in enhancing patient compliance with CI testing.