Failure to Ensure Valid Completion of Advance Directives
Penalty
Summary
The facility failed to ensure that residents' rights to formulate and have valid advance directives were upheld for three of eight residents reviewed. Specifically, the Out of Hospital-Do Not Resuscitate (OOH-DNR) forms for these residents were not completed correctly, lacking required signatures from the resident or their representative, witnesses, and/or the attending physician, which rendered the documents invalid. For example, one resident's DNR form was missing a second required signature, another's form lacked both the second signature and the physician's signature, and a third resident's form was missing a witness signature and was signed by a Family Nurse Practitioner instead of the attending physician as required by the form instructions. Record reviews showed that these residents had significant medical histories, including conditions such as hemiplegia following stroke, dementia, atrial fibrillation, Alzheimer's disease, diabetes, and hypertension. Their care plans indicated DNR orders, and their electronic records reflected DNR code status. However, the deficiencies in the completion of the OOH-DNR forms meant that their wishes regarding resuscitation were not properly documented or legally valid. Additionally, one resident was not listed on the facility's code status list, despite having a DNR order in the chart. Interviews with facility staff, including an LVN, the ADON, and the DON, revealed a lack of awareness regarding the incomplete DNR documentation. The ADON stated that the social worker typically reviewed DNRs, but in their absence, she had taken on the responsibility and was unaware of the errors. The DON also indicated that he and the ADON checked the documents for accuracy but did not know why the deficiencies occurred. The facility's policy and the state OOH-DNR form instructions were reviewed, confirming the requirements for valid completion that were not met in these cases.