Significant Change

[toicole]

Would you need to do one for someone just put on dialysis? This is the only change she has had. Thanks.

[CapeCodMermaid, RN]

Don't the rules say that in order to be a sig change the resident must have had 2 major changes in 2 different areas? If the resident's ability to perform ADLs remains unchanged and everything else is the same,I don't see why it would be a sig change. If I were you. though, I'd wait for Talino to answer...his answers are always right and quote the regs.

[Nascar nurse, ASN, RN]

CCM, you make me chuckle, but you are correct.. Talino is the bomb and has become our very own guru.

CCM is also correct that it takes 2 changes to be a significant change and a Significant change assessment is probably not needed in this instance. Ya may want to really watch for changes tho, as dialysis people tend to be very "wiped out" after dialysis. Could be that they need much more assistance after a dialysis treatment than they would need on other days. THEN you would have a significant change.

[toicole]

Thanks for the replies, I already started her on a quarterly. I didn't think that would make her a Sig. Change, but I wanted to be sure.

[edhcinc]

Hi--would beg to differ on this one...

Although there may be NO difference in some areas of functioning, the RAI Manual, page 2-10, defines a significant change as this:

A "significant change" is a decline or improvement in a resident's status that:

1. Will not normally resolve itself without intervention by staff or by implementing standard disease-related clinical interventions, is not "self-limiting"

2. Impacts more than one area of the resident's health status; and

3. Requ

ires interdisciplinary review and/or revision of the care plan.

Becoming dependent on hemodialysis is one of the more significant life health and life style changes that a client (or any of us) can experience--unless the causative condition, itself, is self-limiting.

On page 2-8 of RAI Manual--"...Changes in the resident's condition that would affect the resident's functional capacity and day-to-day routine should be investigated in a holistic manner through the RAI reassessment. Therefore, concepts associated with significant change are "major" or "appears to be permanent," but a change does not necessarily need to be both major and permanent... Any determination about whether or not a resident has experienced a significant change in status is a clinical decision..."

The diagnosis is new--End stage renal disease. The treatment, surgical creation of a vascular access site, requires monitoring by staff and by the client. Dialysis--3 times per week for 3 to 5 hours--9 to 15 hours of "non-free" time and activity pattern. The client will experience side effects (fluid volume shifts, BP up/down), must have dietary changes/restrictions (nutrition pattern), will experience and be treated for anemia (health condition), and will have a change in urinary output--usually to NONE (elimination pattern). Meal times and actual food intake (how about a "box" breakfast or lunch 3 times a week?), medication times and number of medications, actual daily routine--all will change (and will remain changed) when dialysis begins.

So, perhaps a SCSA is not required today, but it certainly will be required within a week of the start of dialysis. The client's life will undergo significant changes and the care plan must be updated to address these changes.

Good luck with your client...