Version 4.0 Tools have been improved based on ongoing user feedback, and to facilitate incorporation into electronic health records and other forms of health information technology. Important changes include:
1. The SBAR Communication Form and Progress Note has been substantially revised to make it a more comprehensive and user-friendly nursing evaluation that helps guide and document critical thinking in an efficient way. Changes have been made to several areas of terminology in response to user concerns and suggestions.
2. The criteria for notifying the clinician have been made more consistent between the Decision Support Tools (Change in Condition File Cards and Care Paths), and these criteria are now included in the revised SBAR.
3. The Stop and Watch early warning tool has been revised to facilitate its use in routine monitoring of high risk residents by adding a checkbox for "no change".
4. The Advance Care Planning Tracking Tool has been revised to include brief documentation of discussions, which are often not clearly communicated over time or during care transitions.
5. The Quality Improvement Tool for review of acute care transfers has been updated based on review of over 5,000 Tools to be more inclusive of changes in condition that contribute to transfer, as well as those conditions that CMS considers "potentially preventable" hospitalizations.
6. The Implementation Guide has been updated to include all the changes.