MDS Alert

When should you conduct the BIMS -- and what’s the look-back period?

Although the Brief Interview for Mental Status (BIMS) has been around for several years, questions still remain on how — and when — you should perform the interview. And you can’t look to the current Resident Assessment Instrument (RAI) manual for answers.

Remember: Unlike the other MDS 3.0 resident interviews, you’re using the BIMS to determine recall and memory ability, not the resident’s mood, feelings, pain levels or thoughts, Judy Wilhide Brandt, RN, BA, C-NE, RAC-CT, a nationally-renowned MDS expert and consultant, said in a recent Leading Age posting.

Rely on General Guidance for When to Perform the BIMS

Unfortunately, the RAI manual does not mention when you need to conduct the BIMS and gives "no hint of a look-back period," Brandt lamented. But you can look to the general RAI manual instructions, which state that the general look-back period is seven days, unless otherwise stated. And you should not perform the BIMS after the Assessment Reference Date (ARD).

The BIMS is for all "interviewable" residents, which means those who at least sometimes understand, Brandt explains in the posting.

Note: If you judge that you should not conduct a BIMS for a particular resident, you must code C0100: Should Brief Interview for Mental Status Be Conducted? as "No (resident is rarely/never understood)," according to the Polaris Group. Then, you would assess the resident based on observations, completing C0700-C1000: Staff Assessment for Mental Status.

1. Repeat 3 Words for C0200

In the first part of the BIMS, C0200 — Repetition of Three Words, you’ll tell the resident, "I’m going to say three words for you to remember. Please repeat the words after I have said all three. The words are: sock, blue, and bed. Now tell me the three words."

Here’s how to code the responses after the resident’s first attempt:

0 None repeated

1 One repeated

2 Two repeated

3 Three repeated

If the resident correctly states all three words, say: "That’s right, the words are sock, something to wear; blue, a color; and bed, a piece of furniture."

Why? "Category clues assist with learning and help prompt the resident," Brandt explained.

If the resident recalls two or fewer words, say: "Let me say the three words again. They are sock, something to wear; blue, a color; and bed, a piece of furniture. Now tell me the three words." You can repeat the words and category cues a third time if the resident doesn’t recall all three words.

"If the resident does not repeat all three words after three attempts, re-assess the ability to hear," Brandt instructed. "If the resident can hear, move on to the next question. If he or she is unable to hear, attempt to maximize hearing (alter environment, use hearing amplifier) before proceeding."

Remember: Although you can repeat the words up to three times with cues, you must code the MDS based on the first response, Polaris Group states.

2. C0300: Ask 3 Questions for Temporal Orientation

In the second part of the BIMS, C0300 — Temporal Orientation, ask the resident three questions, without providing any cues:

1. Please tell me what year it is right now?

2. What month are we in right now?

3. What day of the week is today?

Tip: "Allow up to 30 seconds for reply, so as not to confuse psychomotor retardation with cognitive impairment," Brandt said.

Here’s how to code the resident’s answers:

A. Able to report correct year

0 Missed by > 5 years or no answer

1 Missed by 2-5 years

2 Missed by 1 year

3 Correct

B. Able to report correct month

0 Missed by > 1 month or no answer

1 Missed by 6 days to 1 month

2 Accurate within 5 days

C. Able to report correct day of the week

0 Incorrect or no answer

1 Correct

Stop: At this point, if the resident provides no verbal or written response to your questions and/or provides nonsensical responses, you can stop the interview, Polaris Group instructs.

If you stop the interview, "code ‘dashes’ in the remaining questions, code 99 in C0500, and complete the staff assessment," Brandt stated.

3. Ascertain Recall for C0400

In the third part of the BIMS, C0400 — Recall, you’ll say: "Let’s go back to an earlier question. What were those three words that I asked you to repeat?" You should allow the resident up to five seconds to spontaneously recall each word, Brandt said. If the resident does not recall one or more words, you can then provide the category clues.

Here’s how you’ll code for this section:

A. Able to recall "sock"

0 No – could not recall

1 Yes, after cueing ("something to wear")

2 Yes, no cue required

B. Able to recall "blue"

0 No – could not recall

1 Yes, after cueing ("a color")

2 Yes, no cue required

C. Able to recall "bed"

0 No – could not recall

1 Yes, after cueing ("a piece of furniture")

2 Yes, no cue required

Tip: Code as "yes, no cue required" if the resident names multiple items in a category, one of which is correct, but only if this is on the first try and without cueing, Brandt said. But if you give the resident cues and the resident then names multiple items in the category, you would code this as "no – could not recall" — even if one of the items the resident listed was correct.

What the Summary Score Means

Unless you had to enter 99 in C0500 — Summary Score because you were unable to complete one or more questions, the computer adds up the resident’s scores and enters a total of 00 to 15 in the Summary Score portion.

"The BIMS total score is highly correlated with Mini-Mental State Exam," Polaris Group notes. Here is what the final scores generally mean:

13 – 15: Cognitively intact.

08 – 12: Moderately impaired.

00 – 07: Severe impairment.