The ability to detect change in a resident's condition is important because
it can prevent illness from getting worse. Nursing staff know the residents
best; therefore they are the best qualified to notice when there is a change in a
resident's condition. Detecting change depends on
all nursing staff (nursing assistants/licensed nurses)
being alert to changes and ready to share their
observations and respond to the changes.
In order to properly assess a change, it is necessary to
know the resident's normal (baseline) condition, assess
the change and compare it with the baseline, and know
which changes might be signs of illness. When there is
a change in condition in an older person, it usually is
less obvious than it would be in a younger person, and
it could mean many different things.
Changes to watch for include those affecting the
way a resident walks, urination and bowel patterns,
skin changes, level of weakness, falls, vital signs,
demeanor, appetite, sleeping, speech, confusion or
agitation, and resident complaints of pain. It may be
necessary to report a change repeatedly.
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Pearls and Pitfalls
- The best way to detect a change in a nursing center resident is to get to know
what is normal for that particular resident.
- You can learn to be observant, and to make a habit of being "tuned in" to
- Older people have less response to change, so the signs and symptoms of illness
they exhibit may be milder or different from those seen in younger people.
- A safe environment supports open reporting of resident changes and doesn't
find fault with reporters.
- When in doubt, report a change.
- Feeling that it is hard to report a change because someone might be blamed is a
barrier to safe care.
- Forgetting to use reporting tools makes it harder for the care team to be alerted
to changes once these are detected.
- Expecting someone else to take action when change is detected does not help
residents stay safe.
- Assuming someone else knows the resident better or knows more than you can
get in the way of your desire to report what you think might be a change.
- Detecting changes can prevent an illness from getting worse.
- Nursing staff know the resident best.
- Nursing staff must be alert to watch for changes.
- The need to share observations and respond to changes is very important.
- Staff must know what's normal for the resident so it can used for comparison when there is a change.
- Staff must know the different changes they need to watch for.
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