MDS Alert

Find out what it could mean if someone passes the cognitive screen but fails the medication transfer task.

Residents who are going home will have to be able to manage their own medication or get some help with this critical task. In fact, being able to take daily medications on time can be a challenge for anyone, especially those with some level of cognitive impairment or health literacy problems.

To combat these common causes of medication mismanagement, Katherine Anderson, PharmD, CGP, has developed a screening tool, the Medi-Cog, which could potentially help nursing facilities assess if a patient or his family caregiver has the skills to organizethe patient's medications independently.Making that assessment part of discharge planning could identify individuals who may require some assistance.

How it works: The Medi-Cog is a combination of the Mini-Cog©, developed by Soo Borson, MD, at the University of Washington, and a pillbox skills screen, which is called the Medication Transfer Screen (MTS), Anderson explains. The MTS "requires the person to read and decipher instructions from different prescriptions, such as, 'take one pill every day in the evening,'" says Anderson, assistant professor of pharmacy practice at Harding University College of Pharmacy. The tool also includes a grid that simulates a pillbox in which the person marks in "pills" based on the prescription instructions. "The person does five tasks on his or her own, filling in the simulated pillbox," says Anderson.

The test is quick: The Mini-Cog© tool involves a three-item recall and a clock draw task which requires two to three minutes to conduct, whereas the Medication Transfer Screen requires about five minutes, Anderson adds. In a study, the Medi-Cog performed "far better" in predicting who could fill their pillbox correctly than the MMSE, Anderson reports. (In the study, a passing score on the MTS was 4 points -- see the tool on page  40.) The Consultant Pharmacist published the study outcomes (Consult Pharm 2008; June;23(6):259-72).

A person who fails the Mini-Cog© but passes the MTS may have undetected cognitive decline. But the person may still be able to complete some questions in the MTS task if they are well-educated and have adequate cognitive reserve, Anderson explains.

On the other hand: The person who passes the Mini-Cog© but fails the MTS could have some health literacy issues. For example, perhaps the person can't read or figure out how to translate the prescription instructions into organizing the medication in the pillbox. "Some patients don't have good literacy due to lack of education or written English skills, but they have high cognitive function," says Anderson. "So if someone tells them to take a pill daily with a meal, they can remember that.

" Further research will look at whether the Medi-Cog has any value in predicting how well someone uses the pillbox after organizing it correctly, which is a "critical piece in medication adherence," Anderson says.