It is often hard to recognize a change in condition in our frail patients. Clinical signs, like an elevated temperature, may not be present and if cognitively impaired the patient may not be able to report any symptoms – pain, sore throat, headache, nausea – to you. So it becomes important for those who know the patients best – nurses aides, therapists, housekeepers, dietary staff, family members – to be alert to the less subtle signs of physiological changes and report them to the nurses in order to assess and manage an acute change in condition as soon as possible.

Many facilities follow Clinical Practice or Stop and Watch Guidelines and provide education on identifying and reporting change in patients. Some of these “red flags” for change include:

  1. “Something is not right”
  2. Communicating less
  3. Not eating as usual
  4. Not drinking
  5. No BM in 3 days
  6. Agitated or more agitated than usual
  7. “Can’t stay awake”
  8. Needed more help with ……. (any ADL)
  9. Skin color change
  10. Refuses to …….. (won’t do something they usually love to do)

Educating and engaging the clinical “eyes and ears” of all those who care for and work around the patients every day is important and can only benefit the patients and the speed at which their condition, if changing acutely, is identified, assessed, and managed. These valuable caregivers are part of the “village” needed to provide the best care for frail patients who are not always able to speak for themselves.

Their engagement in this aspect of patient care represents a win for the patient and a win for the caregivers. Patients will received a more timely assessment and the staff will feel more involved in valuable aspect of patient care.