Failure to Ensure Consistency Between MOLST Forms and EHR Orders
Penalty
Summary
The facility failed to ensure that orders for life-sustaining treatment in the electronic health record (EHR) matched the orders documented on the Maryland Orders for Life Sustaining Treatment (MOLST) forms, and did not maintain the accuracy of physician orders. For one resident, the MOLST form indicated a No CPR (DNR) status with permission to intubate, while the EHR contained an order for DNR and Do Not Intubate (DNI), which did not match the MOLST. Nursing staff reported referencing the MOLST form on the crash cart for code status during emergencies, but would check the EHR for code status during changes in condition. The discrepancy was acknowledged by staff, and it was noted that the MOLST was updated after the EHR order, but the EHR was not promptly updated to reflect the new MOLST instructions. In another case, a resident's MOLST form indicated No CPR, no intubation, and no transfer to the hospital, while the physician's order in the EHR stated DNR, DNI, but allowed transfer to the hospital for unmanaged symptoms. This mismatch between the MOLST and the physician's orders was confirmed by the Director of Nursing and the Nursing Home Administrator during the survey. No additional evidence was provided to resolve the discrepancies by the end of the survey.