Section 483.20(b)(2)(ii) Within 14 days after the day on which the facility determined, or should have determined, that the resident`s physical or mental condition has changed significantly. (For the purposes of this section, a „significant change“ means a significant deterioration or improvement in the resident`s condition that does not normally resolve itself without additional staff intervention or through the implementation of standard clinical interventions related to the illness, that affects more than one area of the resident`s medical condition and requires an interdisciplinary review or revision of the plan of care; Both.) If changes are detected, the main intervention may be to teach this module, but it is likely that there will be a corresponding change in standard operations. For example, daily rounds may add a specific question for each resident: Do you have anything new about Mr. Jones? Or it can add this question to the format that licensed practical nurses use in their oral and written reports for shift change. Each quality improvement effort can have its own intervention to improve change detection. Ms A is a frail (weakened) 79-year-old mentally intact woman who arrived at the Manor Nursing Centre after suffering a hip fracture at home. After a stay in an acute rehabilitation centre, she is still unable to fend for herself. Ms. A walks with difficulty with a walker and needs help with daily activities. Ms. A also has several other medical conditions, including high blood pressure, diabetes and arthritis. She is also being treated for depression.
His family visits him regularly on weekends. She rarely participates in the activities of the Manor Nursing Centre; At mealtimes, she tends to avoid conversation. Recently, she had diarrhea, was incontinent of watery stools, was placed in adult panties, and nurses had to change her adult panties once or twice per shift. She started eating in her room. Stool tests showed that she had an intestinal Clostridium difficile infection. An antibiotic has been put in place. Despite the antibiotic, her stools continued to be fluid and frequent the following week, and she ate less. Her blood pressure was normal for her at 130/80, but her pulse was higher than her usual pulse of 70-75 to 90-100. Yesterday, she had a fever of 102.5 and was transferred to the acute care hospital, where she was admitted to the intensive care unit.
Adult learning involves changes in knowledge, behaviours and skills. Many interventions focus on what is being done – for example, modifying or adding a protocol. These are good, but they often don`t work as well as they could unless they come up with a culture change to appreciate the importance of the new protocol. The best interventions tend to appeal to culture with team meetings and other educational or inspirational materials at the same time as the new protocol. As a rule, cultural change involves the implementation and dissemination of certain basic teachings. Ensure that any resident experiencing a significant change in status is fully assessed using the Resident Assessment Instrument (RAI) process specified by the CMS. The case tells a story. These are similar situations to those of participants at work. They have a discussion that brings what they know and how they might deal with the situation. You want to be sure that different ideas are heard and see if anyone changes their mind.
For an example, see the „Creating the presentation“ section below. An CDSA, including Area of Care (ABA) assessments, must be completed within 14 days of determining that there has been a significant change in the resident`s status from baseline. This can be determined by comparing the resident`s current condition with the last full assessment and the last quarterly assessment, and the resident`s condition is not expected to return to baseline within 2 weeks. A CAWD is appropriate if there are two or more areas of MDS decline or two or more areas of improvement, or if the TDI determines that the resident would benefit from the CDSA assessment and subsequent review of the care plan. The facility should document in the medical record if it is determined that the resident meets the criteria for a significant change in status. Develop participants` knowledge and skills in detecting changes in a resident`s condition. Reach team consensus on priorities and changes that are most likely to lead to improvements, and then decide to take action. Circumstances in which a change in residency status is not significant include, but are not limited to: This training is designed for registered nurses (RN/RPN/NVL), occupational therapists and physiotherapists, and licensed practical nurses. However, some parts of the training are relevant to supervisory and activity staff, which is also important for identifying changes.
The training is designed to be accessible and relevant to all of these health care providers. So you can teach your participants all together and mix professional roles. Then, the project team decides which problem to fix in order to detect the changes. Whatever the intervention, it will likely be important to improve the culture of awareness and the importance given to the issue.