Humerus FX - Sig. Change

[Cecilianurse]

Do I do a significant change for an arm fx with a cast for 6-8 weeks?

[Talino]

The IDT has 14 days to determine how the cast affects a resident's overall function - ADLs, mood, behavior, po intake, etc. Print the most recent MDS and compare the current status if one was done now.

The cast may be inconsequential if a resident is already coded 3 or 4 in most or all ADLs prior to; or it does not compromise resident's overall health or impede ADL independence and activity pursuits. In such cases, SCSA is not required.

If there are 2 or more areas of decline, then the SCSA is appropriate:

• Resident's self-performance in 2 or more areas of ADL were formerly 0, 1, or 2 and is now 3, 4, or 8 with the presence of cast
  
• A behavior problem is worse or onset of mood symptoms due to loss or decline in function
  
• Appetite has decreased, becoming more lethargic, presence of reddened skin areas due to decrease bed mobility, etc.
  

Once you’ve confirmed / documented that a sig. change has occurred, you have another 14 days to complete the SCSA.

[Medicarenurse1]

One thing we tend to forget about sig change is: Is the condition likely to resolve? Now if it was a pathological fx, with underlying cancer or osteoporosis, I would probably see if it's time for hospice, and ask the team for their input. If it was the result of a fall, and is likely to heal, she probably does not need a sig change. I usually ask the team, "Has Ms. Jones changed enough for a sig change assessment?" My team always answers no if I ask it that way, OR, they bring up something that no one else knows that changes the whole picture.