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:
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.)
Elimination changes (urine, stool)
Medication response (e.g., reactions, side-effects)
Digestion changes (e.g., nausea, vomiting, diarrhea)
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.