Stop and Watch Early Warning Tool

INTERACT-style early warning inspection tool for CNAs and frontline staff to systematically identify and document subtle changes in a resident's condition before clinical deterioration occurs. Prompts timely escalation to the nurse.

Resident & Reporter Identification

• Resident Name
  Full name of the resident being observed.
• Room / Bed Number
  Resident's current room and bed assignment.
• Date and Time of Observation
  When the change was first noticed.
• Staff Member Completing This Report
  Name and title of the CNA or frontline staff member completing this tool.
• Shift
  Shift during which the change was observed.

S — Seems Different Than Usual

• Resident seems different than usual today
  A general, non-specific change from the resident's normal baseline — even if you cannot pinpoint exactly what is wrong. Trust your instinct.
• Describe what seems different (if Yes above)
  Provide a brief, specific, observable description of what is different from the resident's normal baseline.

T — Talked or Communicated Less Than Usual

• Resident talked or communicated less than usual
  Noticeable decrease in verbal output, responsiveness to questions, or social engagement compared to the resident's normal communication pattern.
• Resident appears confused, disoriented, or less alert than usual
  New or worsening confusion, difficulty following conversation, or decreased level of alertness — a potential sign of acute change in mental status.

O — Overall Needs More Help Than Usual

• Resident needed more help with ADLs than usual (bathing, dressing, grooming, toileting)
  Required more staff assistance or prompting than is documented in the resident's current care plan baseline.
• Resident had difficulty walking, transferring, or had increased fall risk compared to usual
  New unsteadiness, weakness, or reluctance to bear weight that differs from the resident's established mobility baseline.
• Resident stayed in bed or chair more than usual / did not want to get up
  Unusual inactivity, withdrawal from normal routines, or reluctance to participate in scheduled activities.

P — Pain, Discomfort, or Physical Symptoms

• Resident complained of or showed signs of new or worsening pain
  Verbal complaint of pain, or non-verbal signs such as grimacing, guarding, moaning, or reluctance to move.
• Resident had new or worsening shortness of breath, labored breathing, or coughing
  Any change in respiratory pattern, rate, or effort compared to the resident's normal baseline.
• Resident had new skin changes (redness, swelling, wound, rash, or bruising)
  Any new skin breakdown, pressure injury, unexplained bruising, or rash not previously documented.
• Resident had new or worsening nausea, vomiting, or diarrhea
  Any GI symptoms not present at the prior assessment or worsening beyond the resident's known baseline.
• Resident ate or drank less than half of their meal / refused food or fluids
  Significant reduction in oral intake compared to the resident's normal eating pattern.

Escalation & Nurse Notification

• Were any 'Yes' responses identified in this assessment?
  Summary flag: if any changes were noted above, nurse notification is required.
• Nurse notified of findings
  Confirm that the nurse has been verbally notified of the observed changes documented in this report.
• Name of Nurse Notified
  First and last name of the nurse who received this report.
• Time Nurse Was Notified
  Time the verbal or written notification was made to the nurse.
• Method of Notification
  How the nurse was informed of the observed changes.
• Additional Notes or Context for the Nurse
  Any additional observations, context, or relevant history that may help the nurse assess the resident's condition.
• Staff Signature
  Signature of the CNA or frontline staff member completing this Stop and Watch report.