Failure to Update and Document Advanced Directives and Code Status
Penalty
Summary
The facility failed to ensure that residents' code statuses were accurately updated and that required physician signatures were obtained on advanced directive forms. For one resident with multiple diagnoses including diabetes, cardiomegaly, and hypertension, the clinical record showed a full code status order, while a POST form completed by the resident's POA indicated a DNR status but lacked a physician's signature. The resident herself expressed a desire to be DNR, and facility leadership acknowledged that the form should have been completed by the physician and the code status updated accordingly. Facility policy required that advanced directives be reviewed at admission and quarterly, with nursing staff responsible for confirming code status and obtaining physician orders, but this process was not followed. For another resident with immunodeficiency and other conditions, conflicting code status orders were present in the EHR, with both full code and DNR orders documented within a short period. There was no POST form in the EHR for this resident. Staff interviews revealed confusion regarding which code status to follow when discrepancies existed, with the practice being to use the highest code status. The lack of consistent documentation and failure to obtain and maintain accurate, physician-signed advanced directive forms led to deficiencies in honoring residents' wishes regarding end-of-life care.