Assessment and Documentation of Neuropsychiatric Symptoms in Hospitalized Patients with Dementia
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Other TitlesNeuropsychiatric Assessment for Dementia
SponsorsProblem and purpose: Nursing assessment and documentation of neuropsychiatric symptoms (NPS) for patients with dementia (PwD) are critical for symptom management, treatment and discharge planning. Lack of standardization and inadequate documentation may lead to inadequate treatment, prolonged hospitalization, or denial of admission to care facilities following discharge. The purpose of this quality improvement (QI) project was to improve clinical management of dementia, by implementing an evidence-based protocol for standardized assessment and documentation of NPS, using the Neuropsychiatric Inventory-Questionnaire (NPI-Q). Methods: This QI project was implemented over 12 weeks in late 2020 on a 14-bed inpatient behavioral health unit (BHU) with an average daily census of 1-2 patients with dementia. A validated and reliable tool (the NPI-Q) was introduced to the unit for accurate, standardized assessment of NPS. The number of patients who received the prescribed number of NPI-Q assessments per hospitalization and the number of patients who showed improvements in NPI-Q total and domain scores from admission to discharge were evaluated. Results: The mean age of the patients was 74 years (range 65 to 85); there were equal numbers of males and females. Seventy-four percent of patients received the targeted number of NPI-Q during their hospitalization. Additionally, 67% of patients who received both admission and discharge NPI-Qs had improved NPI-Q scores at discharge. The mean for admission NPI-Q scores was 7.6 (SD = 3.2) compared to discharge NPI-Q scores of 3.4 (SD = 4.3). There were no significant relationships between age and admission NPI-Q scores (p = .4); age and discharge NPI-Q scores (p = 1.0); gender and admission NPI-Q scores (p= 1.0); gender and discharge NPIQ scores (p = 1.0); age and length of stay (LOS), or gender and LOS (p = 1.0). Conclusions: Using a structured, validated instrument is likely to improve assessment and documentation of NPS among patients with dementia in an inpatient BHU. Although the number of assessed patients was small, it appears that this practice change was well accepted by nurses, is sustainable, and may improve communication among health care teams and quality of care, as evidenced by improved NPI-Q scores from admission to discharge.
Keywordbehavioral health unit
Neuropsychiatric Inventory-Questionnaire (NPI-Q)