Failure to Ensure Physician's Order Matched Resident's POLST DNR Status
Penalty
Summary
The facility failed to ensure that a physician's order for code status matched the resident's POLST (Physician Orders for Life-Sustaining Treatment) DNR status for one resident reviewed for advance directives. Specifically, a resident who lacked capacity to make decisions had a POLST form indicating Do Not Attempt Resuscitation (DNR), which was signed by the responsible party. However, there was no corresponding physician's order for the resident's code status at the time the POLST was signed by the responsible party. The physician did not sign the POLST until 55 days after the responsible party had signed it. Facility policy required staff to document the existence of advance directives, review them for completeness, confirm their currency with the resident or legal decision maker, and notify the treating physician to obtain appropriate orders. Interviews with staff, including the SSD and DON, confirmed that every resident should have a physician's order for code status and that the POLST must be signed by a physician to be effective. The absence of a timely physician's order for the resident's DNR status was verified through medical record review and staff interviews.