Failure to Complete POLST for Resident with Significant Medical Needs
Penalty
Summary
The facility failed to ensure that a Physician Orders for Life-Sustaining Treatment (POLST) was completed for a resident with significant medical conditions, including heart failure and metabolic encephalopathy. Upon review of the resident's admission record, it was found that the resident was not oriented to time, had poor recall, and exhibited symptoms such as trouble concentrating and feeling down or hopeless. During observation, the resident was found in bed with bed rails up, receiving oxygen via nasal cannula, and had a Foley catheter in place. Interviews with facility staff revealed confusion regarding responsibility for obtaining and completing the POLST form. The Registered Nurse Supervisor indicated that the POLST was blank and deferred responsibility to Social Services, who in turn stated that nursing staff should complete the form. The DON stated that an advance directive had been obtained and believed that a POLST was not necessary if an advance directive was present, although later acknowledged that the POLST should not replace the advance directive and that all residents should have a POLST. A review of facility policy and state guidance confirmed that the POLST is a legally valid physician order intended to complement, not replace, an advance directive. Despite this, the resident's POLST was not completed, and staff interviews demonstrated a lack of clarity regarding the process and responsibility for ensuring the form was in place. This failure had the potential to result in the resident's end-of-life wishes not being followed in the event of an emergency, as the necessary documentation was not available or completed as required by facility policy.