Sig. Change

[Cecilianurse]

Experts,

I have a resident in sub-acute unit, on med A and undergoing chemo on admission 5/7.

Now, she has declined significantly extensive to total. Do I have to do a sig. change?

Thank you!

[silverbat]

If you expect the decline to last more than 14 days. I would do the Sig change .

[Talino]

Just to clarify

According to the guideline ...

Decline in two or more of the following:

• Resident’s decision-making changes;
  
• Presence of a resident mood item not previously reported by the resident or staff and/or an increase in the symptom frequency (PHQ-9©), e.g., increase in the number of areas where behavioral symptoms are coded as being present and/or the frequency of a symptom increases for items in Section E (Behavior);
  
• Any decline in an ADL physical functioning area where a resident is newly coded as Extensive assistance, Total dependence, or Activity did not occur since last assessment;
  
• Resident’s incontinence pattern changes or there was placement of an indwelling catheter;
  
• Emergence of unplanned weight loss problem (5% change in 30 days or 10% change in 180 days);
  
• Emergence of a new pressure ulcer at Stage II or higher or worsening in pressure ulcer status;
  
• Resident begins to use trunk restraint or a chair that prevents rising when it was not used before; and/or
  
• Overall deterioration of resident’s condition.
  

The 3rd bullet would suggest the decline applies ONLY if the ADL was previously coded 0, 1, or 2 and now coded 3, 4, or 8

However, this one change should not deter the staff from determining that a sig. change is eminent. Like Silver says, you will have up to 14 days to assess further.