Improving Patient Safety in Long-Term Care Facilities: Module 1: Detecting Change in a Resident

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Improving Patient Safety in Long-Term Care
FacilitiesModule 1 Detecting Change in a
Residents Condition

• Student Version

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Module 1 Detecting Change in a Residents
Condition
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Noticing Changes Is Important

• Detecting changes can prevent illness from
  getting worse
• Staff must

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Recognize Baseline Status

• Know the residents baseline
• Recognize different types of changes
• Recognize change early on
• Any significant change from baseline can signal
  an important change!

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Physical Changes

• Walking
• Urination/bowel patterns
• Skin quality
• Level of weakness
• Falls
• Vital signs

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Non-physical Changes

• Demeanor
• Appetite
• Sleep
• Confusion
• Agitation
• Pain

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Principles in Action Recognizing Change

• Poor balance?
• Change in vital signs?
• Sudden incontinence or constipation?
• Falls more often?
• Easily fatigued?
• Avoids group activities?
• Leaves food on plate/tray?
• Sleeping more than previously?
• Difficulty speaking?
• Wincing in pain?

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Everyone Must Watch for Change
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Other Observers of Change

• Family
• Other visitors
• Housekeeping staff
• Volunteers
• Chaplains
• Receptionists

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Reporting Change

• Changes must be
• Recognized
• Documented
• Reported
• Improves patient safety

When in doubt, report!
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Communicating Change

• Essential to patient care
• Helps keep residents safe
• Changes should be reported openly whenever they
  happen
• Show you care by speaking up!

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How and Where to Report Change

• Team meetings
• Shift changes
• Verbal reporting and charting
• Tools
• SBAR
• Early Warning Tool

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SBAR

• SBAR http//interact2.net/docs/INTERACT20Version
  203.020Tools/Communication20Tools/Communication
  20Within20the20Nursing20Home/INTERACT20SBAR2
  0Form20v820Jan2014202013.pdf

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Principles in ActionSBAR Nursing Assistant to
Nurse

• Situation
• Ms C fell asleep in her clothes this evening and
  cursed at me.
• Background
• She is the 85-year-old from room C6.
• She is usually friendly and does her own ADLs.
• Assessment
• She seems okay physically, but I am worried.
• Recommendation
• Id feel better if you would take a look at her
  and make an assessment.

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Early Warning Tool

• Prompts nursing assistants to stop and watch
  for changes.
• Write down changes.
• Communicate changes to healthcare team.
• Early Warning Tool
• http//www.in.gov/isdh/files/Doc_7_-_Interact_Sto
  p_and_Watch_Tool.pdf

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Case Study
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Admission NoteSarah Jones Dec 21, 2013

• New resident
• 89 years old s/p hip replacement
• Uses walker
• Mentally intact
• On arrival, all vitals within normal limits
• Excellent bladder control
• Appetite excellent

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Sarah Jones Dec 22-30, 2013

• Day 6 Refuses to go to dining room
• Day 7 Complains of low back pain
• Day 7 Has two episodes of urinary incontinence
• Day 8 Temperature is 101o
• Day 9 Complains of pain during urination
• Day 9 Requires adult continence pads

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Key Points

• Recognize residents baseline.
• Be aware of any change in residents condition.
• Physical
• Nonphysical
• Seek input from other team members.
• Share observations in a safe, collaborative
  environment.