Failure to Verify and Legalize Advance Directives for DNR Orders
Penalty
Summary
The facility failed to ensure that advance directives, specifically Do Not Resuscitate (DNR) orders, were properly verified and legally executed for several residents. For one resident with multiple significant medical conditions, including morbid obesity, chronic kidney disease, atrial fibrillation, hyperkalemia, heart failure, and hypertension, the electronic health record and care plan indicated a DNR status. However, the scanned DNR directive in the resident's record was not signed by a physician, rendering it not legally valid. Interviews with nursing and administrative staff confirmed that a valid DNR requires both the resident's (or legal representative's) and physician's signatures, and that the current document did not meet these requirements. Facility policy required that advance directives be complete, maintained in the clinical record, and reviewed quarterly or upon significant change. Despite these policies, the resident's DNR directive lacked the necessary physician signature, and staff acknowledged this deficiency. The failure to ensure the DNR directive was properly executed and legally valid was identified through observation, record review, and staff interviews, and was not limited to a single resident.