Stop and Watch Early Warning Tool

INTERACT-style early warning checklist for CNAs and frontline staff to identify and report subtle changes in a resident's condition to the nurse before clinical deterioration occurs. Based on the INTERACT Stop and Watch tool used in long-term care settings.

Resident & Staff Identification

• Resident Name
  Full name of the resident being observed.
• Room / Unit
  Resident's room number and unit or wing.
• Date and Time of Observation
  Record the exact date and time when the change was first noticed.
• Reporting Staff Member Name and Role
  Full name and role (e.g., CNA, HHA, Med Aide) of the staff member completing this tool.
• Nurse Notified
  Name of the nurse who was notified or to whom this report will be handed off.

STOP — Something Is Not Right

• Instruction: Check all signs of change observed below
  Select every change you have noticed compared to this resident's normal baseline. If you are unsure, select the item and describe it in the comments. Do not wait until you are certain — early reporting saves lives.
• Seems different than usual
  A general sense that something is 'off' or not right — even if you cannot pinpoint exactly what it is. Trust your instincts as someone who knows this resident.
• Talks or communicates less than usual
  Resident is quieter, less talkative, not responding to conversation, or withdrawing from social interaction compared to their normal behavior.
• Overall needs more help than usual
  Resident requires more assistance with ADLs (activities of daily living) such as dressing, bathing, eating, or mobility than is typical for them.
• Participates less in activities than usual
  Resident is disengaged, uninterested, or refusing to participate in activities they normally enjoy or attend.
• Confused or more confused than usual
  Resident appears disoriented, is asking repetitive questions, does not recognize familiar people or places, or shows increased confusion compared to their baseline cognitive status.
• Agitated or nervous more than usual
  Resident appears more anxious, restless, combative, or emotionally distressed than is typical for them.
• Had a fall or complained of dizziness
  Resident fell, nearly fell, reported feeling dizzy, lightheaded, or unsteady on their feet.
• Complained of pain or discomfort
  Resident verbally reported pain, or displayed non-verbal signs of pain such as grimacing, guarding, moaning, or reluctance to move.

WATCH — Physical Signs of Change

• Ate less than usual at meal(s)
  Resident consumed noticeably less food or fluid than is typical for them. Note which meal(s) were affected in the comments.
• Had trouble breathing
  Resident appeared short of breath, was breathing faster or slower than normal, was using accessory muscles to breathe, or complained of difficulty breathing.
• Had a change in skin color or condition
  Resident's skin appears pale, flushed, yellow (jaundiced), bluish (cyanotic), mottled, or there is a new wound, rash, bruise, or skin breakdown not previously documented.
• Had a change in urine (color, amount, odor, or frequency)
  Urine appears dark, cloudy, bloody, or has a strong/foul odor; resident is urinating much more or less than usual, or has new incontinence.
• Had a change in bowel habits
  Resident has not had a bowel movement in 3+ days, has new diarrhea, or stool appears black, tarry, or bloody.
• Had a change in weight
  Resident has gained or lost weight noticeably, or clothing/shoes/rings appear tighter or looser than usual (may indicate fluid retention or loss).
• Swollen feet, ankles, or legs (edema)
  Resident's lower extremities appear more swollen than usual, or pitting edema is observed.
• Coughing or choking more than usual
  Resident has a new or worsening cough, is coughing during or after meals, or is showing signs of aspiration risk.

Description of Change & Nurse Notification

• Describe the change(s) you observed in your own words
  Be specific and objective. Include when the change was first noticed, how it differs from the resident's normal baseline, and any relevant context (e.g., 'Mrs. Jones refused breakfast and lunch today and is sleeping more than usual — she normally eats well and participates in bingo').
• How long has this change been present?
  Estimate how long the observed change has been occurring.
• Nurse has been verbally notified of this change
  Confirm that you have communicated this observation directly to the nurse on duty. This form does NOT replace verbal notification — it supplements it.
• Time nurse was notified
  Record the time you spoke with the nurse.
• Photo of observed change (if applicable)
  If the change involves a visible physical finding (e.g., skin change, swelling, wound), attach a photo per your facility's policy.
• Staff Signature
  Signature of the CNA or frontline staff member completing this report.