This is the current release of the guideline.

This guideline was reaffirmed for currency by the developer in 2011.

Acute change of condition (e.g., physical, behavioral, cognitive, or functional)

Elderly residents of long-term care facilities with or at risk for an acute change of condition

Note: These guidelines apply substantially to individuals who come to long-term care facilities for short-term care.

Diagnosis/Assessment

1. Identifying individuals at risk for acute changes in condition (ACOCs)
2. Describing and documenting symptoms and/or condition changes
3. Defining patient’s stability and identifying why the situation is problematic
4. Determining the feasibility of identifying the causes(s) of the ACOC in the facility
5. Identifying and documenting the likely causes of the ACOC

Management/Treatment

1. Determining the feasibility of managing the ACOC in the facility
2. Identifying appropriate treatment goals and objectives that consider the patient's wishes
3. Managing the ACOC
4. Monitoring the patient's progress
5. Adjusting interventions and goals based on the patient's response to treatment
6. Reviewing the facilities management of ACOCs and unplanned hospital transfers

Hospital admissions from long-term care facilities

2003 Guideline

Not stated

2011 Review Process

MEDLINE and PubMed were searched for updated literature related to the subject published between June 2009 and January 2011. This search is done annually and completed by the clinical practice committee vice-chair. If new literature does not change the content or scope of the original guideline, it is deemed to be current.

Not stated

Not applicable

Not stated

The guideline was developed by an interdisciplinary work group using a process that combined evidence- and consensus-based thinking. The groups were composed of practitioners involved in patient care in the institutional setting. Using pertinent articles and information and a draft outline, the group worked to make a simple, user-friendly guideline that focused on application in the long-term care institutional setting.

Not applicable

A formal cost analysis was not performed and published cost analyses were not reviewed.

All American Medical Directors Association (AMDA) clinical practice guidelines undergo external review. The draft guideline is sent to approximately 175+ reviewers. These reviewers include AMDA physician members and independent physicians, specialists, and organizations that are knowledgeable of the guideline topic and the long-term care setting.

The algorithm Acute Change of Condition (ACOC) in the long-term care setting is to be used in conjunction with the clinical practice guideline. The numbers next to the different components of the algorithm correspond with the steps in the text. Refer to the "Guideline Availability" field for information on obtaining the full text guideline.

An algorithm is provided for Acute Change of Condition.

The guideline was developed by an interdisciplinary work group using a process that combined evidence- and consensus-based thinking.

The approach to recognition, assessment, treatment, and monitoring of acute changes of condition (ACOCs) that is proposed in this guideline should result in better management of these events in the long-term care facility and fewer transfers to hospitals and other acute-care settings.

Not stated

The implementation of this clinical practice guideline (CPG) is outlined in four phases. Each phase presents a series of steps, which should be carried out in the process of implementing the practices presented in this guideline. Each phase is summarized below.

1. Recognition
   • Define the area of improvement and determine if there is a CPG available for the defined area. Then evaluate the pertinence and feasibility of implementing the CPG.
2. Assessment
   • Define the functions necessary for implementation and then educate and train staff. Assess and document performance and outcome indicators and then develop a system to measure outcomes.
3. Implementation
   • Identify and document how each step of the CPG will be carried out and develop an implementation timetable.
   • Identify individual responsible for each step of the CPG.
   • Identify support systems that impact the direct care.
   • Educate and train appropriate individuals in specific CPG implementation and then implement the CPG.
4. Monitoring
   • Evaluate performance based on relevant indicators and identify areas for improvement.
   • Evaluate the predefined performance measures and obtain and provide feedback.

Not applicable: The guideline was not adapted from another source.

Organizational participants included:

• American Association of Homes and Services for the Aging
• American College of Health Care Administrators
• American Geriatrics Society
• American Health Care Association
• American Society of Consultant Pharmacists
• National Association of Directors of Nursing Administration in Long-Term Care
• National Association of Geriatric Nursing Assistants
• National Conference of Gerontological Nurse Practitioners

American Medical Directors Association

Steering Committee

Naushira Pandya, MD, CMD, Project Chair

Steven Levenson, MD, CMD, Clinical Practice Committee Chair

Steering Committee Members: Donna Brickley, RN; Lisa Cantrell, RN, C; Charles Cefalu, MD, MS; Sherrie Dornberger, RNC, FADONA; Sandra Fitzler, RN; Joseph Gruber, RPh, FASCP, CGP; Larry Lawhorne, MD, CMD; Steven Levenson, MD, CMD; Susan M. Levy, MD, CMD; Harlan Martin, RPh, CCP, FASCP; Geri Mendelson, RN, CNAA, MEd, NHA; Evvie F. Munley; Jonathan Musher, MD, CMD; Mary Tellis-Nayak RN, MSN; Barbara Resnick, PhD, CRNP; William Simonson, PharmD, FASCP, CGP

Not stated

This is the current release of the guideline.

This guideline was reaffirmed for currency by the developer in 2011.

Electronic copies: None available

Print copies: Available from the American Medical Directors Association, 10480 Little Patuxent Pkwy, Suite 760, Columbia, MD 21044. Telephone: (800) 876-2632 or (410) 740-9743; Fax (410) 740-4572. Web site: www.amda.com .

The following are available:

• Guideline implementation: clinical practice guidelines. Columbia, MD: American Medical Directors Association, 1998, 28 p.
• We care: implementing clinical practice guidelines tool kit. Columbia, MD: American Medical Directors Association, 2003.

Electronic copies: None available

Print copies: Available from the American Medical Directors Association, 10480 Little Patuxent Pkwy, Suite 760, Columbia, MD 21044. Telephone: (800) 876-2632 or (410) 740-9743; Fax (410) 740-4572. Web site: www.amda.com .

None available

This NGC summary was completed by ECRI on July 6, 2004. The information was verified by the guideline developer on August 4, 2004. The currency of the guideline was reaffirmed by the developer in 2011 and this summary was updated by ECRI Institute on May 11, 2012.

This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions. For more information, please contact the American Medical Directors Association (AMDA) at (800) 876-2632.