Reads the person and the moment

Spotting Change Early in Health, Mood and Behaviour

A CORA decision skill · about a 4-minute read

Somebody can be getting unwell for a fortnight before it is written down anywhere. Usually not because it was invisible, but because nobody asked in a way that person could answer, and what changed got put down to how they are.

Spot the Change means

Notice shifts in health, mood or behaviour early.

What it looks like on shift

  • Somebody is eating less than usual, and you say so rather than assuming the next shift will notice too.
  • A person who normally paces is sitting still, and you treat that as information rather than a quiet shift.
  • You notice a change from THEIR baseline, not from what you would expect of anybody else.

What it looks like when it slips

  • Waiting for a change to become obvious enough that nobody could argue with you.
  • Comparing somebody to a general expectation instead of to how they usually are.
  • Noticing, and telling nobody, because it did not feel big enough to be worth mentioning.

Three things to try on your next shift

  1. Learn one person's baseline properly. How much do they normally eat, sleep, move, talk? You cannot spot a change from a baseline you never learned.
  2. Say the small thing out loud even when it feels like nothing. “Probably nothing, but” is a complete and useful sentence.
  3. Write it down with a date. Three small notes across a fortnight are what let somebody else see a slow drift. Anything that is worrying you today does not wait for the third note.

Some changes do not wait for handover

Handover is the right home for the slow drift. Eating a bit less, sleeping worse, quieter than they were last week. It is the wrong home for the thing that is worrying you right now. If you are uneasy about somebody in front of you, that goes to whoever can act, and it goes at the time, not at the end of the shift.

You are not expected to work out how serious it is. That is the whole reason it gets passed to somebody else rather than decided by you. Nobody is in trouble for raising something that turned out to be nothing.

Which means knowing your organisation's policy before the shift where you need it. Who you ring after hours, what the number actually is, and the point where it stops being a phone call to your team leader and becomes 000.

Before you act: Always follow your own organisation's policy first. For a suspected poisoning or medication error, the Poisons Information Centre is 13 11 26. In an emergency, call 000.

Related reading: Escalate Well covers the judgement itself: what goes up, when, and who it goes to.

More in Reads the person and the moment:

  • Read the RoomClock the real emotional/behavioural signal under the surface and respond to that.
  • Recognise & ReframeSee past deficit labels/assumptions to what's actually happening; correct an unhelpful frame.

All ten decision skills →