A&O x 3?

[KyleC]

I am revising our flow sheets and I struggle somewhat with the ever-present "Awake & Alert x 3."

I feel like this statement is appropriate for the elderly, where individuals with dementia may become confused about when/where/who they are. In the DD setting however, it's not as simple as asking. Individuals who do not speak can be fully aware of where they are, who they are, what time of day it is and what day of the week it is. Sometimes we can infer that a person is oriented x 3 based on their behaviors, but I'm sure there are individuals who are more alert/oriented than they are able to express.

Does anyone on here have an alternative shorthand for recording mental status on a flow sheet, which is appropriate for the DD setting?

Thank you,

Kyle

[osi2011]

In my experience working in a residential group home serving DD patients, our flow sheet contained "seizure activity" and if not we will document that the patient was awake and alert during such and such shift....most of our patients have seizure disorders or had a history of seizures so it is important to have awake and alert as part of documentation....im not sure if I answered your question?

[KyleC]

I made a typo by writing Awake & Alert. I agree with that observation. A&O x 3, however, means that the person is awake and oriented to person, place, and time. It's easy to assess in a hospital or nursing home--you ask their name, where they are, who the president is, etc. But it's not so easy in a DD setting, where many individuals can't respond to such questions, but still have some awareness of where they are, who they are, and when it is. I am thinking of simply removing A&O x 3 from our flow sheets and replacing with Awake & Alert.

[txredheadnurse, BSN, RN]

I always used awake and reactive to their environment. IMO for the non verbal or lower functional clients this is a more accurate reflection of how they do interact and how the direct care staff tends to judge the clients functionality and mood on any given day or shift.

[MunoRN, RN]

I think that in general the "A&O x3" thing needs to go away regardless. Depending on the nurse, A&Ox3 might mean they are fully oriented, although another nurse might call a patient A&Ox3 because they aren't fully oriented (they are oriented to 3 out of 4 parameters instead of using 3 out of 3).