Acute Change of Condition Reporting Guide
Included in the Agency for Healthcare Research and Quality’s (AHRQ’s) educational materials to improve resident safety
in long-term care is a list of the top 12 changes in resident condition to watch for. The following physical and nonphysical changes are important to detect and report. For more comprehensive information, view the student workbook,
Improving Patient Safety in Long-Term Care Facilitiesi Module 1: Detecting Change in a Resident’s Condition.
Physical Changes
Changes to Report
1. Walking
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Trouble starting
Poor balance
Smaller or shuffling steps
Wider steps
Favoring one side
2. Urination and
Bowel Patterns
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New lack of bladder control
Decreased urine output
New constipation
Diarrhea
3. Skin
 Reddened or darkened skin near a
pressure point
 Skin breakdown
 Swollen, puffy or red skin
 Dry or cracked lips
 New rash
4. Level of Weakness
 New general weakness—whole body
fatigue
 Local weakness
 Sudden vs gradual weakness
 Environment
o Slippery floors
o Objects in the way
 Person specific
o Medications
o Medical conditions
o State of mind
 Temperature
 Respiratory rate
 Blood pressure
 Pulse rate
5. Falls Risk
6. Vital Signs*
Possible Indication or Risk
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At risk for a fall
Broken bone
Worsening arthritis
Stroke
Medical contributing to confusion
Medication problems
Medication problems
Infection
Dehydration
Kidney failure
Bowels
Stool impaction
Pressure ulcer
Skin infection
Blood clot
Excess fluid
Dehydration
Oral infection
Allergic reaction
Various illnesses
Stroke
Various illnesses
 Fall
*Should be measured during every
suspicion of clinical change
Acute Change of Condition Reporting Guide
Non-Physical Changes
Changes to Report
7. Demeanor (i.e.,
appearance or way
of acting)
8. Appetite
 Changes from baseline
o Withdrawal
o Passivity
o Not wanting to socialize
o Talkative
o Inattentive
 Loss of appetite
 Increased hunger
 Change in food preferences
 Pain from eating
9. Sleeping
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Not feeling rested
Unable to fall asleep
Difficult to rouse from sleep
Difficulty breathing
10. Speech
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New slurred speech
New garbled speech
Speaking loudly
Difficult finding the right words
New levels of confusion or delirium
Talking more or less than normal
Not making sense
Refusing or resisting care
11. Confusion or
Agitation
Note: Many residents may
have some confusion at
baseline.
12. Resident
Complaints of Pain
 New or worsening chronic pain
 Acute pain
Possible Indication or Risk
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Bloodstream infection
Stroke
Depression
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Medication problems
Infection
Chronic congestion
Stomach problems
Dental problems
Depression
Dementia
Delirium
Pain
Anxiety
Depression
Lung problems
Medication
Stroke
Sleep deprived
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Pain
Medication
Pneumonia
Urosepsis
Dehydration
Stroke
Arthritis
Heart attack
Major blood vessel weakening
Weakening of the bowel wall
i
Improving Patient Safety in Long-Term Care Facilities. July 2012. Agency for Healthcare Research and Quality, Rockville, MD.
http://www.ahrq.gov/professionals/systems/long-term-care/resources/facilities/ptsafety/index.html.
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