Resident condition change: should I call 911?

Identifiers of illness, including catastrophic change, are based on a set of assumptions that are not always true or accurate for older adults. Atypical findings in combination with the more subtle or different presentation of illness can result in missed opportunities for early treatment and prevention of more dire consequences. Assessment instruments described in this article can guide the investigation and communication of a resident's change in status: SPICES (Sleep; Problems with Eating and Feeding; Incontinence; Confusion; Evidence of Falls; Skin Breakdown), FANCAPES (Fluid; Aeration; Nutrition; Cognition/Communication; Activity/Abilities; Pain; Elimination; Skin/Socialization), DELIRIUM (Drug use: Electrolyte imbalance; Lack of scheduled meds; Infection; Reduced sensory input; Intracranial problems; Urinary problems; Myocardial problems), PQRST (Provokes/Palliates; Quality/Quantity; Region/Radiates; Severity; Timing) and COLDSPA (Character; Onset; Location; Duration; Severity; Pattern; Associated Symptoms), (for pain assessment). "Should I call?" scenarios are described using case studies. A systematic approach to assessment, recognition of change in functional status, protocols to guide calling for emergency assistance, and structured communication are essential elements of early recognition of illness, can reduce caregiver anxiety, and improve the health care outcomes for the resident. Imagine you or one of your staff standing in the dining room of your residence and looking at the residents for whose health and well-being you are responsible. Could you spot someone who was not doing well? Who might be ailing? If you saw 2 residents who looked ill, whom would you assess first? How would you decide? Identification of illness, including catastrophic change, is based on a set of assumptions that are not always true for older adults and can result in a set of findings that does not fit with our conventional understanding and knowledge of illness presentation. All too often, these atypical findings in combination with the more subtle presentation of illness in older adults results in missed opportunities for early treatment. A systematic approach to assessment, recognition of change, protocols to guide calling for emergency assistance, and communication with other health care providers are essential elements of early recognition of illness that can decrease health care provider anxiety and improve outcomes. This article describes 2 evidence-based assessment instruments: the SPICES tool, which should be used routinely as a first-line method for recognizing change and preventing deepening complications or acute illness, and the FANCAPES tool, which evaluates change in condition. In addition, several acronyms that can guide symptom assessment are provided. Immediately life-threatening conditions and 3 "don't miss" signs of emergencies are discussed, as are nursing interventions for the geriatric emergency. "Should I call?" scenarios are presented in a table that includes common signs and symptoms and recommended nursing actions of who to call. Two case studies illustrate the assessment instruments and analysis of data. Basic information that should be included in a transfer document is described. The article includes a communication model known as SBAR (Situation, Background, Assessment, Recommendation) that can be implemented and used by all staff of the assisted living residence.