Failure to identify and treat a resident change in condition continues to be a hot spot button for litigation? It has been in the “top 3” for many years and as we promote the “aging in place” philosophy, residents may be at higher risk for experiencing changes in condition. The federal regulations are clear:
A “significant change in condition” is a major decline or improvement in a resident’s status that:
- Will not normally resolve itself without intervention by staff or by implementing standard disease-related clinical interventions; the decline is not considered “self-limiting”;
- Impacts more than one area of the resident’s health status; and
- Requires interdisciplinary review and/or revision of the care plan.
Sounds simple right? Sadly, it isn’t, many times we fail to identify a significant change in condition resulting in a negative outcome. Why? There are many reasons, sometimes the change is subtle and may not really present as significant for days or weeks, or maybe our staff may need additional training in identifying subtle changes. Keep in mind that it may be as subtle as “George didn’t eat dessert today” when George requests an extra dessert every day. Do staff remove George’s tray and not ask George about the “change”? Many times, the answer is yes but maybe, just maybe if staff were trained to say “hey George, why didn’t you eat your dessert” we could identify that something is going on!
The goal of F637 §483.20(b)(2)(ii) is to ensure each resident who experiences a significant change in status is comprehensively assessed using the CMS-specified Resident Assessment Instrument (RAI) process. Investigating “why” a change has occurred and addressing it on the resident care plan. It isn’t rocket science but it is something we need to stay on top of.
Talk to staff about subtle changes observed during meals (high risk for choking, weight loss, etc. that may be insidious at first glimpse). Have your OT/PT staff round to observe positioning issues, swallowing deficits, and a need for additional assistive devices. AND of course, use a stop and watch tool for everyone to be able to share unusual observations. You got this, carry on! Stay well and stay informed!