An acute change of condition is a sudden, clinically important deviation from a resident’s baseline in physical, cognitive, behavioral, or functional status. It is essential to notice and report change in a resident’s condition, and it is everyone’s responsibility to do so. Staff should know the signs of illness in older adults and other nursing center residents, and they should know how to watch for and report changes in a resident’s condition.
Acute changes of condition are very common in long-term care facility residents. Some are unpredictable, but many can be anticipated by identifying risk factors such as pre-existing conditions, previous complications, or the course of a recent hospitalization. Newly admitted residents are considerably more vulnerable especially if they have had a recent hospitalization, acute illness or other event that may have disrupted their stability. It is important that risks for acute condition changes be identified upon or soon after admission or readmission, or after an acute illness or significant change in condition. Examples of acute changes in condition that could be predicable include: delirium in a resident who recently had pneumonia; falling in a resident who has had changes in medication to address elevated blood pressure; and fever in a resident who has had a recent bladder catheterization.
A change in a resident’s condition may mean that he or she is at risk. Action can be taken only if changes are noticed and reported, the earlier the better. Changes that are not reported can lead to serious outcomes, including medical complications, transfer to a hospital, or even death. In order to identify a change in condition and know when to report it, staff need to understand what is normal (baseline) for a particular resident’s condition when he or she first comes into the nursing center, and over time after that. Armed with this information, staff will be able to identify changes and decide which ones need to be reported to others on the care team. The resident’s recent history is also often relevant to acute change in condition risk. All hospital discharge information should be reviewed carefully and information should be actively sought from a variety of sources such as family members, hospital practitioners and staff that cared for the resident prior to admission to the nursing facility.
Stages of assessment and recognition of an acute change in condition apply to all symptom categories and include: initial observation and reporting of signs and symptoms by individuals in close contact with the resident; additional clinical observation to help define the nature, severity and possible causes of the problem; and advanced clinical analysis of the nature, severity, and possible causes of the problem. Immediate notification of a physician is warranted when any symptom, sign or apparent discomfort is sudden in onset, more severe in relation to usual symptoms and signs, and cannot be relieved by measures that are currently prescribed for the resident.
Education of staff in relation to the recognition of an acute change of condition and identification of its nature, severity and causes is the key that can enable staff to manage a resident at the facility and avoid transfer to a hospital or emergency room.