N20 — Preventive Care and Screening Review

When: Admission, the scheduled care-plan review, transplant workup, or a new change in function or symptoms.

Do this

1. Check that the care plan names who follows vaccinations/hepatitis status, diabetes care, cancer screening, and other agreed preventive care; record completion and the next action.
2. Ask about appetite, function, mood, sleep, memory, falls, and treatment burden. Use the unit's screening tools and referral pathway rather than relying only on monthly labs.
3. Reconcile screening decisions with goals of care, transplant candidacy, expected benefit, prior results, and the patient's preferences [1].
4. Track symptoms that need diagnostic evaluation, including new bleeding, hematuria, a mass, persistent unexplained weight loss, or a marked change in energy/function.

Call / escalate

• Acute confusion, a new neurologic deficit, severe symptoms, or suicidal thoughts with immediate safety concerns: use the urgent assessment pathway.
• New concerning symptoms, persistent mood/memory changes, an uncompleted referral, or unclear screening responsibility: contact the appropriate clinician and document follow-through.

Don't

• Do not order a blanket cancer or thyroid screening panel for every dialysis patient, or automatically repeat a test because a calendar year has passed.
• Do not dismiss symptoms because routine screening was deferred or a quality dashboard is green. Screening and diagnostic evaluation are different.