Failure to Honor Resident’s Documented DNR Status
Penalty
Summary
The deficiency involves the facility’s failure to honor and implement a resident’s documented DNR (do not resuscitate) status as indicated on a valid POLST (Physician Orders for Life-Sustaining Treatment) form. The resident was admitted from a hospital with discharge orders clearly indicating DNR status, and a POLST form dated later in the month also documented the resident as DNR. The resident’s healthcare POA was identified in a POA document, and the POA stated that the facility had a signed POLST form but reported being told by facility staff that they could not honor it until the facility’s medical director signed off on the DNR. Despite these existing documents, a physician order entered shortly after admission listed the resident as Full Code. The admission care plan documented that the resident was cognitively impaired but did not include any information related to advance directives. The facility’s DON confirmed that if a resident has a POLST form signed by a physician, the facility is supposed to honor it and that the medical director’s additional signature is not required for validity. Upon reviewing the POLST, hospital discharge orders, and current admission orders, the DON acknowledged not knowing why the resident was listed as Full Code and stated the resident should be DNR. The facility’s own policy on Residents’ Rights Regarding Treatment and Advance Directives states that upon admission, existing advance directives are to be copied, placed in the chart, documented in the medical record, and communicated to staff, but this was not carried out for this resident’s DNR status.
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