Failure to Update Care Plan After Change in Code Status
Penalty
Summary
The facility failed to update a resident’s care plan to reflect a change in code status from Full Code to Do Not Resuscitate (DNR). The resident was admitted with dementia and epilepsy and had a death with dignity care plan that documented a wish for cardiopulmonary resuscitation (CPR) to be attempted. A social worker’s progress note documented that the resident’s family changed the code status to DNR, and a physician subsequently wrote a DNR order. The resident’s comprehensive MDS indicated he was rarely or never understood, underscoring reliance on documented directives rather than resident self-report. Despite these documented changes, the care plan continued to list the resident as Full Code. During interviews, the social worker confirmed the code status change and described the process of placing new or updated code status forms in the physician’s notebook for review and signature, with the physician then writing an order in the chart. The social worker did not recall informing the MDS nurses of the code status change or whether it was discussed in the morning meeting. The two MDS nurses, who stated they were responsible for updating care plans including code status changes, reported they relied on information from the morning meeting for changes in orders or resident condition and did not recall the code status change being reported. The Administrator stated that the resident’s current code status should be reflected on the care plan and acknowledged that the care plan should have been updated when the code status changed.
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