Failure to Verify Code Status and Inform of Advance Directive Rights
Penalty
Summary
The facility failed to inform a resident and/or her responsible party of their right to formulate an advanced directive upon admission, and did not clarify the resident's code status to ensure her end-of-life care wishes would be honored. The facility's policy required social services to verify a patient's code status within one business day of admission, but this was not done for the resident in question. The resident was admitted to the facility after a hospital stay for serious medical conditions, including a fall and multiple types of brain hemorrhages, and was assessed as alert and oriented to person and time but not to place or situation. Upon admission, the facility did not attempt to determine if the resident had an advanced directive or wanted to create one. The resident's hospital discharge summary indicated a DNR/DNI status, but this information was not verified or documented by the facility. When the resident experienced a medical emergency, CPR was initiated without confirmation of her code status, leading to a situation where emergency medical technicians had to contact the resident's son to confirm whether CPR should continue. Interviews with facility staff revealed that the resident was considered Full Code by default upon admission, as the social services assessment to confirm code status had not yet been completed. The facility's failure to verify the resident's code status and inform her of her rights regarding advanced directives resulted in a lack of clarity during a critical medical event, ultimately leading to the continuation of CPR against the resident's documented wishes.
Plan Of Correction
1. R1 is no longer in our facility. 2. A baseline audit will be completed to verify that all patients have an opportunity to formulate an advanced directive, including code status. 3. The Advanced Directive P&P will be updated. 4. The DON or designee will create an Advanced Directive assessment. 5. The Advanced Directive assessment will be completed by the admitting nurse when each patient arrives. 6. The licensed nurses will be in-serviced on the newly created AD Assessment. 7. For the next sixty (60) days, the DON or designee will complete random audits to ensure that the Advanced Directive Assessment is being completed correctly. 8. The DON or designee will report patterns and trends from these audits to the facility QA Committee. 9. The DON or designee will monitor for compliance.