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ACOC Module 2: Why Worry About an ACOC?

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Rebecca Moonah

on 5 December 2012

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Transcript of ACOC Module 2: Why Worry About an ACOC?

Acute change of condition
(ACOC) in long-term care: Recall: What is an ACOC? Why worry about an ACOC? An acute change of condition (ACOC) can cause tremendous anxiety, stress, and fear for the resident, family members and staff. Remember... ACOCs are very common in LTC residents.

An acute change of condition (ACOC) may occur abruptly or over several hours to several days.

Some ACOCs are unpredictable but many can be anticipated.

By identifying ACOCs, residents maybe managed in the LTC home and avoid being transferred to busy emergency department. Also... Early signs and symptoms of a problem may be ambiguous and non-specific (e.g., decreased appetite, agitation, lethargy, falls, weakness, disorientation) but are important to observe and monitor as they may be early indications of an ACOC.

Early detection of ACOC signs and symptoms can help to avoid poor outcomes and negative impact on quality of life. What front-line caregivers...
PSWs and RPNs need to know… Prepared by:
Diane MacEachern RN(EC) BScN NP-PHC MScN(c)
Central East Community Care Access Centre, NPSTAT Module 2
Why worry about an ACOC? ACOCs also can result in hospitalizations and put residents at risk of serious health problems, greater functional decline and a loss of independence. (AMDA 2003) (AMDA 2003) The main goal in identifying
an ACOC is to: To achieve this goal: All caregivers must learn to recognize an ACOC and identify its nature, severity and cause(s).
All caregivers must observe for behavioural and functional health symptoms - never underestimate their importance
Everyone must remember that residents may not report their physical complaints due to cognitive and communication impairments or an inability to even recognize their symptoms due to multiple physical and functional conditions 1. enable staff to properly assess/evaluate and
manage a resident in the long term care home
2. avoid a transfer to the local emergency
department Whenever possible, hospitalization of
LTC residents should be avoided: Transfer to the ED is disruptive, expensive, exposes residents to many risks including delirium, poor nutrition, serious infections, skin breakdown, adverse drug reactions and contributes to rapid deconditioning and a loss of indenpendence
On the other hand, care in the LTC home occurs in a familiar environment, involves known caregivers, family members and is more comforting for the resident Bottom line: Many ACOCs can be identified and managed within the LTC Home! (Alessi and Harker, 1998; Boockwar, Brodie and Lachs, 2000; Boockwar and Lachs, 2002 & 2003; Longo et al., 2004). References Alessi, C.A., & Harker, J.O. (1998). A prospective study of acute illness in the nursing home. Aging Clin. Exp. Res., 10 (6), 479-489.

American Medical Directors Association. (2003). Acute change of condition in long-term care setting. Clinical practice guideline. Columbia, MD: Author. Retrieved from: www.amda.com

Boockvar, K., Brodie, H.D., & Lachs, M. (2000). Nursing assistants detect behavior changes in nursing home residents that precede acute illness: Development and validation of an illness warning instrument. Journal of the American Geriatrics Society, 48, 1086-1091.

Boockvar, K., & Lachs, M. (2002). Development of definitions for acute illness. Journal of the American Medical Directors Association, 2, 279-284.
Hamilton Long-Term Care Best Practices Workgroup . (2007). Best Practices Approach to Acute Change of Condition in LTC Homes Resource Kit. Central South Ministry of Health and Long-Term Care .

Longo, D.R., Young, J., Mehr, D., Lindbloom, E., & Salerno, L. (2004). Barriers to timely care of acute infections in nursing homes: A preliminary qualitative study. Journal of the American Medical Directors Association, 5, S5-S10. (AMDA 2003) Don't Forget... Many ACOCs can be anticipated managed within the LTC home Hospitalization of LTC residents should be avoided
Transfer to the ER or hospital is disruptive, costly, exposes residents to many risks including delirium, undernutrition, serious infections, skin breakdown and adverse drug reactions. By contrast, care in the LTC home occurs in a familiar environment, involves family and is more comforting.
Timely evaluation and intervention is necessary to address ACOCs effectively in the LTC home. Most often, an ACOC represents a change from a resident’s well-established and documented baseline.
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