Inconsistency in Resident's Advance Directive and Physician Orders
Penalty
Summary
The facility failed to ensure consistency between physician orders and the resident's Physician Order for Life Sustaining Treatment (POLST) for one resident. The facility's policy requires that the Director of Nursing Services or designee notify the attending physician of any advance directives or changes to them, ensuring that appropriate orders are documented in the resident's medical record and plan of care. However, for Resident R13, there was a discrepancy between the physician's order, which indicated cardiopulmonary resuscitation (CPR), and the POLST, which specified a Do Not Resuscitate-Allow Natural Death (DNR) order with limited additional interventions. Resident R13 was admitted with diagnoses including Type I diabetes, hypertension, and vitamin D deficiency. The inconsistency was confirmed during an interview with the Registered Nurse Supervisor, who acknowledged that the physician's orders and the POLST were not aligned. This discrepancy indicates a failure to honor the resident's documented treatment preferences as outlined in their advance directive.
Plan Of Correction
Nursing staff identified the proper code status with family for resident R13 to ensure the proper treatment plan is in process and updated. The Facility has educated staff on the policy of advanced directives along with accuracy. Facility has done an audit of all residents to determine appropriate code status is correct per resident's wishes and matches in the EMR along with the POLST. DON or designee will audit all new admissions for 6 weeks for accurate documentation of POLST vs order in the EMR. POLST will be reviewed with care plan meetings. We will review this as part of our Quality Assurance Performance Improvement meeting (QAPI) and audit quarterly.