• American Medical Directors Association (AMDA). Acute change of condition in the long-term care setting. Columbia (MD): American Medical Directors Association (AMDA); 2003. 29 p. [22 references]

This is the current release of the guideline.

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

Evaluation
Management
Risk Assessment
Treatment

Family Practice
Geriatrics
Internal Medicine

Advanced Practice Nurses
Allied Health Personnel
Dietitians
Health Care Providers
Nurses
Occupational Therapists
Pharmacists
Physical Therapists
Physician Assistants
Physicians
Social Workers
Speech-Language Pathologists

• To improve the quality of care delivered to patients with an acute change of condition (ACOC) in long-term care facilities
• To guide care decisions and to define roles and responsibilities of appropriate care staff

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

Searches of Electronic Databases

Not stated

Not stated

Expert Consensus

Not applicable

Review

Not stated

Expert Consensus

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.

External Peer Review
Internal Peer Review

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 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

• This clinical practice guideline is provided for discussion and educational purposes only and should not be used or in any way relied upon without consultation with and supervision of a qualified physician based on the case history and medical condition of a particular patient. The American Medical Directors Association, its heirs, executors, administrators, successors, and assigns hereby disclaim any and all liability for damages of whatever kind resulting from the use, negligent or otherwise, of this clinical practice guideline.
• The utilization of the American Medical Director Association’s Clinical Practice Guideline does not preclude compliance with State and Federal regulation as well as facility policies and procedures. They are not substitutes for the experience and judgment of clinicians and care-givers. The Clinical Practice Guidelines are not to be considered as standards of care but are developed to enhance the clinician's ability to practice.

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.

Getting Better

Effectiveness
Patient-centeredness
Timeliness

• American Medical Directors Association (AMDA). Acute change of condition in the long-term care setting. Columbia (MD): American Medical Directors Association (AMDA); 2003. 29 p. [22 references]

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

2003

American Medical Directors Association - Professional Association

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.

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.

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.