New or worsening communication deficit: a new expressive aphasia (or a sudden worsening of speech) not present on the last assessment — concerning for a new stroke or an acute neurologic change. Assessed against the baseline and for associated deficits (a positive BE-FAST screen), the stroke/transfer pathway activated, the provider and responsible party notified, and time last-known-well documented. Reassessment on return; supports the Section B/I update. Skilled recognition required, as a new communication deficit is time-critical. (The neurologic exam routes to the Neurological reference.)
Model abnormal 2
Communication breakdown threatening safety: the established method failing so that the resident could not reliably report needs, with a period in which pain or a change may have gone unreported — a safety problem. The method re-evaluated and rebuilt, a reliable call-signal re-established, the resident reassessed for any unreported pain or change, SLP and the provider engaged, and the plan revised. Will reassess the method’s reliability; supports the Section B update. Skilled re-establishment of a safe communication method required.
