Incomplete POLST Form Lacking Required Signatures and Provider Information
Penalty
Summary
The facility failed to ensure that a completed Physician Orders for Life-Sustaining Treatment (POLST) form was readily accessible and properly executed for one of five sampled residents. During record review, it was found that the resident's POLST form indicated selections for No CPR and selective treatment, and was filled out by the resident's responsible party. However, the form was missing the responsible party's signature, the provider's signature, the date, and the printed name of the provider. This incomplete documentation meant the POLST was not valid according to facility policy and state requirements. During an interview, a staff member stated that admission forms, including POLST forms, are typically reviewed by staff, the resident, or the responsible party, and sometimes provided to the responsible party to complete before admission. The staff member was unable to explain why the POLST for this resident was not fully completed with all required signatures and information. Facility policy and provided guidance clearly require both the provider's and the legal decision-maker's signatures for the POLST to be valid.