Change in Condition

Risk – Failure to recognize, monitor and appropriately respond to a change in condition.  Changes in resident condition may be subtle and progress over several hours, shifts or days.

Risk Management Strategies:

  • Competency-Based Education – Provide competency-based education and training on change in condition recognition, reporting and response. Provide training that includes possible high-risk clinical presentations for the residents being served (e.g., diabetic patients, dialysis patients, cardiac and respiratory presentations).

  • Policy and Procedures – Develop policy and procedures that provide guidance for emergency response and reporting.

  • Shift Report – Ensure that shift report includes Resident Safety Status, Changes in Health and Emotional/Social Needs. Some examples to consider:

    • Resident Safety:

      • Mobility Changes/Fall Risk

      • Skin Injury Risk

      • Observed Behaviors That Pose a Safety Risk (e.g., wandering, restless, not using their safety equipment, confusion, aggression, talking about going somewhere – home, to work, etc.)

      1. Health Changes:

        • Nutrition/Hydration

        • Elimination changes (urine, stool)

        • Dizziness/Slurred Speech

        • Pain

        • Medication response (e.g., reactions, side-effects)

        • Respiratory/cardiac changes

        • Digestion changes (e.g., nausea, vomiting, diarrhea)

        • Skin changes

        • Behavior/cognition changes

        • Weakness/fatigue

        • Other

      2. Emotional/Social:

        • Depression/Sadness/Withdrawn

          1. Anger

          2. Declining Care

  • Structured Communication Process – Utilize a structured communication process such as SBAR (Situation, Background, Assessment and Recommendation) for transitions in care and hand-off communication. (Source – Institute for Healthcare Improvement. SBAR Tool)

  • Change in Condition Transfers – Evaluate change in condition transfers to the emergency room or hospital through the quality improvement process including timely recognition and response of the resident’s change in condition.