Failure to Involve POA in Advance Directive and Code Status Decisions
Penalty
Summary
The facility failed to ensure that a resident's power of attorney (POA) was involved in developing and updating advanced directives in accordance with the resident's previously stated wishes. The resident had a notarized advanced directive specifying a desire for comfort care only and authorizing the agent to decline or terminate life-prolonging treatments in the event of a terminal condition with no reasonable prospect of recovery. Despite this, subsequent Clinicians Orders for Life Sustaining Treatment (COLST) forms indicated the resident was a Full Code, and these forms were not signed by the resident or the POA. There was no documented evidence that the resident or POA was consulted regarding the change to full code status. Physician notes indicated awareness of the need to review the resident's health care proxy and discuss goals of care and code status, especially in light of the resident's decline and inability to make medical decisions due to advanced dementia. The Director of Nursing confirmed that the COLST forms were not signed by the resident or POA and acknowledged that the family had not been contacted about the code status change, citing disagreements and hope that the resident would regain decision-making capacity.