Deficient Completion and Implementation of POLST Forms and Inconsistent Code Status Documentation
Penalty
Summary
The facility failed to ensure the timely and complete execution of Provider Orders for Life-Sustaining Treatment (POLST) forms for several residents. Specifically, for three residents, the POLST forms were missing required signatures, printed names, or dates in mandatory sections, including the absence of the resident or responsible party's signature and the physician's signature and date. In one case, the form was signed by a physician without verification of who was making life-sustaining choices for the resident. In another, the physician did not print their name or fill in the date, and in a third, the mandatory physician signature and date were left blank, rendering the form invalid according to Montana state requirements. Staff interviews revealed that the process for obtaining physician signatures could be delayed by up to a month, and there was a misunderstanding among staff regarding the validity of unsigned POLST forms. Additionally, the facility failed to ensure consistency in documenting a resident's code status. For one resident, the POLST indicated a Do Not Resuscitate (DNR) status, while physician orders and admission paperwork reflected a full code status, with conflicting information about the authority of the resident's representative to make healthcare decisions. The daily nursing report listed the resident as DNR, but the physician had changed the code status based on the representative's input, despite the representative only having financial, not healthcare, power of attorney. These deficiencies demonstrate lapses in the facility's processes for accurately documenting and implementing residents' treatment preferences and code statuses.