Failure to Obtain Physician Signature on OOH-DNR Form
Penalty
Summary
The facility failed to ensure that a resident's Out-of-Hospital Do-Not-Resuscitate (OOH-DNR) form was properly completed, specifically lacking the required physician's signature. The resident in question was a cognitively intact female with multiple cardiac-related diagnoses, including syncope, hypertensive urgency, mitral valve disorder, atrioventricular block, paroxysmal atrial fibrillation, and somnolence. Her care plan and physician orders indicated a DNR status, and the resident had signed the OOH-DNR form, but the attending physician had not signed the document as required. Interviews with facility staff revealed that the process for completing DNR forms involved the social worker providing the form to the resident or family, obtaining necessary signatures, and then forwarding the form to medical records for the physician's signature. Staff acknowledged that the DNR form was not considered complete without the physician's signature, but the form was still placed in the binder at the nurse's station even if incomplete. The medical records staff stated that they attempted to obtain the physician's signature within 24 hours, but in this case, the form remained unsigned by the physician until the surveyor's inquiry. Further interviews with nursing and administrative staff confirmed that the code status was updated in the electronic record system and DNR binder based on the resident or responsible party's signature, even if the physician had not yet signed the form. Staff also indicated that there was no set timeframe for obtaining the physician's signature, and the process could be delayed if the physician was not present in the facility. The facility's policy required that advance directives be supported and facilitated, but the lack of a physician's signature on the OOH-DNR form meant the directive was incomplete at the time of review.