Failure to Obtain Physician Signature on DNR Order
Penalty
Summary
The facility failed to ensure that a resident's advance directive, specifically a Do Not Resuscitate (DNR) order, was properly completed and validated according to policy and regulatory requirements. The DNR order for one resident was only signed by two licensed nurses as a verbal order and lacked the required physician signature, rendering the document invalid. This deficiency was identified through review of the resident's electronic health record, which showed the DNR order in the scanned documents section without a physician or provider signature. Interviews with facility staff, including a licensed nurse, the social service designee, and the administrative nurse, confirmed that the DNR was incomplete and that the expectation was for all DNRs to be signed by a physician. The resident involved had diagnoses of dementia, depression, and anxiety, with severely impaired cognition as indicated by a Brief Interview for Mental Status (BIMS) score of zero. The resident was totally dependent on staff for all activities of daily living and was receiving hospice services, with an anticipated decline in all care areas. The facility's policy required that advance directives be reviewed upon admission and at least annually, and that records be maintained in accordance with federal and state law. Despite these requirements, the DNR order for this resident was not properly executed, as it lacked the necessary physician signature.