Quality Statement 1: Comprehensive Assessment - Health Quality Ontario (HQO)

Resources Quality Statements Advisory Committee About

1

Comprehensive Assessment

People living with dementia and symptoms of agitation or aggression receive a comprehensive interprofessional assessment when symptoms are first identified and after each transition in care.

Background

A comprehensive assessment ensures an accurate diagnosis and the collection of baseline information. The assessment allows for the identification of potential underlying conditions or issues (e.g., physical, cognitive, functional, psychiatric, psychosocial, and environmental factors) that may be causes of behavioural and psychological symptoms, and thus informs care for people living with dementia with symptoms of agitation or aggression. The patient, family/caregiver, or substitute decision-maker should be included in the assessment. The assessment also provides the opportunity to establish likely factors (or “triggers”) that may contribute to future occurrences of agitation or aggression. Comprehensive assessments should be performed at a person’s initial presentation to a health care setting as well as at transitions between care settings.

What This Quality Statement Means

For Patients

You should receive an examination and full assessment every time you arrive at or leave a hospital or long-term care home. An assessment means that your care team will want to learn more about you to understand how best to help you. It should include questions about your physical health, your medical history, what medications you’re taking, how you spend your time, and how you’re feeling.

For Clinicians

Perform a standardized, comprehensive assessment (as described in the Definitions section of this statement) when people present to a hospital or long-term care home, or when they transition to another care setting.

For Health Services

Ensure hospitals and long-term care homes have comprehensive assessment tools, systems, processes, and resources in place to assess people at presentation and discharge.

Quality Indicators

Process Indicator

Percentage of people living with dementia and symptoms of agitation or aggression who receive a comprehensive assessment at first presentation or after a transition in care

Denominator: total number of people living with dementia and symptoms of agitation or aggression who initially present at a hospital or long-term care home or who transition to another care setting
Numerator: number of people in the denominator who receive a comprehensive assessment
Data sources: local data collection, Resident Assessment Instrument Minimum Data Set (RAI-MDS) in long-term care homes

Definitions Used Within This Quality Statement

Comprehensive interprofessional assessment

This includes, at a minimum, the following components:

Physical health assessment, medical history, and medication review
Cognitive and functional assessments
Psychiatric and behavioural assessments for other conditions (e.g., depression, suicidality, danger to self and others, potential for aggression)
Psychosocial assessment (e.g., for abuse or neglect, inadequate supervision, poor communication, interpersonal conflict, lack of engagement or activities, personal social history)
Physical environment assessment (e.g., for overcrowding, lack of privacy)
Investigation and treatment of potential contributing factors to symptoms of agitation or aggression (e.g., pain, discomfort, delirium)

Interprofessional care team

At least one physician and one other regulated professional who specialize in dementia care are included on the team. Other regulated and unregulated health professionals on the team may include nurses, psychologists, occupational therapists, pharmacists, behavioural support workers, social workers, caregivers, administrative staff, personal support workers, speech-language pathologists, physiotherapists, geriatricians, dietitians, and recreational staff.

Evidence to Improve Care