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When the vent comes off- is that patient now going to get OOB, walk around, be independent with ADLs, or be able improve with them, maybe with skilled therapy? Is the trach itself permament? What is the total picture? Was the trach/vent a temporary thing from an accident, a surgery? Is that patient moribund/bedbound, normally, so the vent really has no effect on his physical functional status, or overall medical status or prognosis?
you have to look at the overall picture of the resident and whether or not the situation is limited like a resident who is normally ambualatory and gets the flu during their assessment window and spends most of the week in bed or a wheelchair. while they likely met the two or more changes for a sig change they are expected to return to their prior level of function once they are over their illness. so then i would likely not do a sig change. another area where you only need 1 criteria is a resident who has been total care maybe even comfort measures they have no real change in mood, behavior, pain, cognition or ADLs but family wants hospice then you are required to do a sig change even thought the resident has not acutally experienced a new decline. Hope this helps