Failure to Honor Resident's Advance Directive for Code Status
Penalty
Summary
The facility failed to honor a resident's advance directive regarding code status. The resident had a Power of Attorney (POA) document specifying that she wanted life-support treatment to the greatest extent possible for at least 30 days, after which her preference would change to not wanting life-support if certain conditions existed. This document was signed by the resident while she was competent. Additionally, a code status form signed by the resident indicated her wish to receive CPR in the event of cardiopulmonary arrest. Later, when the resident was determined to be unable to make healthcare decisions, the POA was activated, and the resident's daughter, acting as POA, signed a DNR (Do Not Resuscitate) order for the resident, which contradicted the resident's previously expressed wishes in her advance directive and code status form. The Director of Nursing (DON) acknowledged the conflicting information between the resident's advance directive and the DNR order signed by the POA. There was no documentation of any discussion with the POA regarding the resident's express wishes prior to the change in code status. When interviewed, the resident appeared confused but verbally expressed a desire for CPR. The facility's policy required honoring residents' wishes as expressed in valid advance directives, but this was not followed in this case, resulting in the resident's end-of-life care decisions not being honored.