Running Head: ACUTE CHANGE IN CONDITION

Acute Change in Condition Michael MacKay Kaplan University NU 499-02: Bachelors Capstone in Nursing Tina Eslinger Vaughn, MSN RN-C 16 January 2011

Running Head: ACUTE CHANGE IN CONDITION Acute Change in Condition

An Acute change of condition, or ACOC, is a sudden, clinically important deviation from a patients baseline in physical, cognitive, behavioral, or functional domains. Clinically important means a deviation that, without intervention, may result in complications or death (AMDA, 2003). In the long term care unit where I will be completing my Capstone practicum these changes create serious problems for the facilitys budget, and more importantly, can be very dangerous for the residents. What occurs is that a patient, who on last assessment, presents with an acute condition. Perhaps they have a decrease in level of consciousness, or a bed sore that has become infected. Sometimes their blood pressure will be through the roof, putting them at risk for stroke, or they might have a new onset of chest pain. Regardless, the current process for treating them is long and costly, both for the facility and patient. Procedure Currently, when a patient presents with an ACOC, the one discovering the change informs the nurse overseeing the patients care. An assessment is done and often repeated by the charge nurse. If there is something wrong, the doctor is paged. This is a very only process as often times the doctor, who sees every patient in the facility, fails to respond promptly. When the doctor calls, more often than not, he instructs the nurse to send the patient to the emergency room. This is a very frustrating process for all involved. The patients rarely want to go to the hospital, the transfer itself is very time consuming and costly, for the unit has to pay for the ambulance, and the ER staff gets irritated because the patients condition is rarely an emergency. Having worked both in a unit like this and the ER, I can understand both sides.

Running Head: ACUTE CHANGE IN CONDITION

What I propose to do is to create a new kind of documentation for these acute changes in condition. Again, what happens now is a lot of confusion and uncertainty regarding the patients health, and a much time and money is wasted trying to figure out what is wrong. Little to no paperwork is completed save for some nursing notes and a transfer packet. What is needed are new forms that can be completed by everyone involved. This is where I would be acting as a designer of care, by creating new policies and procedures for the staff to treat patients. Providers of Care When all is completed, hopefully, there will be a new early warning report of sorts, that the CNA can fill out if he or she feels that there has been a change in the patients condition. A similar report will also be created for the floor nurse so that all important information can be filled out in a timely manner. This is the manager of care idea. The nurse is responsible for making sure that their patient gets the care that they need. The charge nurse would be more of a manager of care in these situations. Supervising the care of all the residents on the unit, they need to be especially thorough and involve themselves in the plan of care for a patient with an ACOC. The department of health has issued a memorandum regarding changes in condition to long term care facilities. They have included guidelines to help formulate new polices and procedures for these situations. Know what happens on both sides of these changes, I have a unique perspective which will help me integrate these new ideas. If nothing else, hopefully my documents will help patients receive the care that they need (Department of Community Health, 2004).

Running Head: ACUTE CHANGE IN CONDITION

References AMDA. (2003). Acute change in condition in long term care setting. AMDA website. Retrieved from http://www.amda.com/tools/cpg/acoc.cfm Department of Community Health. (29 June, 2004). Process guideline for acute change of condition. Lansing, MI: Bureau of Health Systems.