Notifying Physicians and Family of Resident's Condition

Federal and state requirements mandate that the resident's physician and family members be notified of changes in a resident's condition that affect health. This includes severe illnesses warranting a transfer to the hospital as well as illnesses such as urinary tract infections and pressure sores.

When there is a sudden change of condition, the nursing home nurse is responsible to perform a complete assessment of vital signs and of the basic problem, and notify the physician. If the physician in not available, the medical director must be notified. If the medical director cannot be reached, then 911 must be called. The resident’s healthcare representative must also be notified.

The following are examples of times when the physician must be immediately notified of a change in condition. After the physician is notified and the resident is stabilized, the nursing home staff are responsible to notify a family member or responsible party of this information as well in order to meet federal and state requirements.

• Signs of an impending stroke such as facial drooping, numbness in extremity, or sudden loss of use
• Sudden decline in mental status
• Episodes of bleeding such as bloody vomitus, bloody stools not due to hemorrhoids, and dark, bloody urine
• New onset of chest pain, chest pain not relieved by nitroglycerin, or chest pain accompanied by changes in vital signs, sweating, nausea, vomiting or shortness of breath
• Three or more loose stools in 24 hours
• Any loose stool with evidence of dehydration and changes in vital signs
• Vomitus that has blood or coffee grounds
• Normal looking vomitus of 3 or more times in 24 hours
• Any episode of vomiting with change in vital signs or evidence of dehydration
• Inability to place a feeding tube immediately after removal
• Inability to irrigate a feeding tube after trying to unclog it
• Inability to verify placement of a feeding tube
• Fall with obvious deformity of an extremity
• Fall with pain with change in function
• Fall with head injury and mental status changes
• Fall with cuts or lacerations with poorly controlled bleeding
• Any lab value that is reported as a panic or critical lab value
• Medication errors that cause the resident to have negative symptoms
• Medication errors that have the potential to cause significant side effects
• Medication errors related to not administering medication with the potential to cause harm
• Medication errors resulting from administering medication when the resident has a known allergy to the medication
• New onset of seizures
• Shortness of breath that is sudden in onset, with chest pain, and/or with change in vital signs
• Skin rash with itching, swelling about the face and neck, and/or noted to be with new medication or treatment
• Pressure sores - greater than one stage II (have some depth), any Stage II with a measurement >1 cm, any stage III (through fatty tissue) or Stage IV (down to muscle, tendon, and bone)
• Worsening of any pressure sore
• Vital signs changes such as the following:
  • Increase or decrease in systolic blood pressure (top number) by 30 points
  • Increase in pulse by 20 beats per minute
  • Pulse below 50 beats per minute
  • Increase or decrease in respirations by 6 breaths per minute
  • Temperature rise by 2 degrees
  • Oxygen saturation less than 90%
• A change in behavior that places a resident at a danger to himself/herself or others
• Urine culture with over 100,000 bacteria with symptoms of a urinary tract infection
• X-ray with new findings

Resources

American Medical Directors Association

Annuals of Internal Medicine