Module 1: Detecting Change in a Resident's Condition


In Summary

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


  1. The best way to detect a change in a nursing center resident is to get to know what is normal for that particular resident.
  2. You can learn to be observant, and to make a habit of being "tuned in" to residents.
  3. 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.
  4. A safe environment supports open reporting of resident changes and doesn't find fault with reporters.
  5. When in doubt, report a change.


  1. Feeling that it is hard to report a change because someone might be blamed is a barrier to safe care.
  2. Forgetting to use reporting tools makes it harder for the care team to be alerted to changes once these are detected.
  3. Expecting someone else to take action when change is detected does not help residents stay safe.
  4. 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.

Summing Up:

  • 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.
Page last reviewed October 2014
Page originally created June 2012
Internet Citation: Conclusion. Content last reviewed October 2014. Agency for Healthcare Research and Quality, Rockville, MD.