Failure to Inform POA Prior to Diagnostic Procedure
Penalty
Summary
Facility staff failed to fully inform the Power of Attorney (POA) of a resident prior to conducting a diagnostic procedure. The resident, who was under hospice care and had a history of a possible left knee disarticulation, was noted by a nurse to have significant changes and visible pain in the affected leg. Although the hospice nurse had previously discussed the situation with the POA, who declined an X-ray and opted for comfort care, facility staff later ordered and performed an X-ray without documented evidence of further discussion with the POA regarding this change in care. Documentation reviewed by the surveyor showed conflicting notes regarding the POA's wishes, with one entry stating the POA declined the X-ray and another indicating the POA was not opposed to X-rays but only to surgical intervention. Interviews with facility staff confirmed that there was no documentation supporting that the POA was consulted before the X-ray was performed, despite the prior refusal. The Assistant Director of Nursing acknowledged that staff were expected to inform providers of the resident's hospice status and the POA's prior decisions, but this was not documented as having occurred.