Failure to Timely Implement and Enter Advance Directive Code Status Orders
Penalty
Summary
The facility failed to ensure that residents' advance directives and code status orders were obtained and implemented timely upon admission or readmission. For one resident with diagnoses including hypertensive emergency, acute pulmonary edema, and Sjogren syndrome, the hospital discharge summary identified the resident as DNR-Comfort Care Arrest (DNRCCA) at the time of admission. However, no physician order for code status was initiated until several days later, and when it was entered, the resident was listed as Full Code. Although DNRCCA paperwork was signed by the physician and later uploaded into the electronic health record, the corresponding physician order in the record continued to reflect Full Code status. For another resident with conditions including a stage 4 pressure ulcer, paraplegia, generalized anxiety disorder, major depressive disorder, and neuromuscular bladder dysfunction, DNRCCA paperwork was signed by the physician and uploaded into the electronic medical record, but no physician order for code status was entered into the record following the resident’s readmission from a hospital stay. Interviews with the Regional Director of Clinical Services, the Vice President of Clinical Services, and the DON confirmed that code status orders were either delayed, incorrect, or missing, despite the facility’s policy requiring that, after execution of the Ohio Advance Directive form, a nurse obtain a physician order consistent with the resident’s wishes and enter that order into the electronic health record.
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