Failure to Ensure Consistent DNR Orders with Resident’s POLST
Penalty
Summary
The facility failed to ensure that a resident’s advance directive and code status were clearly and consistently established in the medical record. Facility policy stated that all residents are presumed to have consented to CPR unless there is documentation in the medical record specifying that a DNR order be written, and that any advance directive must be accompanied by a physician’s order. For one resident, the care plan documented a presumed advance directive that CPR would be performed as needed, in line with the default presumption of full code. However, a Pennsylvania Orders for Life-Sustaining Treatment (POLST) form for this same resident indicated that in the event the resident had no pulse and was not breathing, staff were to not attempt resuscitation and to allow natural death (DNR). Review of the resident’s current physician orders revealed no documented physician order addressing the resident’s DNR status as indicated on the POLST. The Regional Clinical Director confirmed that there was no physician’s order for the resident’s DNR directive and that the care plan and POLST were inconsistent. The resident had been admitted with diagnoses including a pressure ulcer of the left buttock, severe protein-calorie malnutrition, and schizophrenia.
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