Change in Condition

As a caregiver, it is your responsibility to identify and report when a resident has a change in his or her condition. Most facility policies will want the charge nurse to notify the resident, his or her attending physician and the resident’s responsible party, for any change in condition.

It may be appropriate for a nurse to notify the physician and the resident’s responsible party in the following when the following situations have occurred:

  • Accident or incident involving the resident

  • Discovery of injuries of an unknown source

  • Reaction to medication

  • Significant change in resident’s physical, emotional or mental condition

  • Need to change the resident’s medical treatment

  • A critical lab-value has been discovered- this requires a phone call to the physician

  • Need to transfer the resident to a hospital or acute treatment center


Make sure to note in the resident’s medical record the change in status as well as any conversations or attempts to notify the appropriate people.


If you are caring for a resident for the first time, you may not know what is normal for the resident. You have resources available including the medical chart, nursing notes, permanent staff and even the resident his/herself. Before calling the physician, make sure you have the appropriate information readily available, including but not limited to:

  • Full set of vital signs

  • Blood glucose if the resident is diabetic

  • Information on how the resident has been prior to this time, such as the previous shift

  • Current symptoms

  • What you’ve done so far

  • The medical chart including current medication list

  • Any other pertinent information


Ultimately-trust your instincts. If you feel that something is off- assess, notify, monitor. It’s better to be safe than sorry. Cliché but true.


                                                                                   Reducing Acute-Care Transfers

With a change in condition can often come the potential for a transfer to a hospital for evaluation. Sometimes, this transfer is medically necessary for the resident to receive appropriate treatment. However, many times the appropriate treatment can be provided within the walls of the nursing home.


Transferring a resident out of the facility, which is his or her home, to a hospital, can be stressful and difficult. It is important as caregivers that we do all we can to prevent unnecessary transfers, which place undo stress on an already compromised resident.

Many nursing homes have the necessary equipment to initiate or maintain intravenous treatment or have emergency medication kits on-site, which allows prompt initiation of antibiotics or other medications.


Having a thorough assessment and understanding of the resident’s condition as well as his or her history can be vital in preventing an unnecessary transfer. Also, it’s appropriate to notify the physician and to let him/her know that you are simply notifying and don’t feel that the resident necessary needs to go to a hospital at this time.


With thorough assessment of the resident, the nurse should be able to identify some potential interventions to recommend to the doctor prior to send the resident to the hospital. Interventions that may be appropriate to try include but are not limited to:

  • Initiating oxygen

  • Encouraging fluids

  • Initiating standing orders for certain situations, when appropriate

  • Requesting orders for certain medications to be given at the nursing home, such as Lasix for increased edema. Then recommending monitoring condition.


Of course, following the facility policies and procedures prior to implementing any standing orders.


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