Improperly Executed DNR Order Due to Missing Witness Dates
Penalty
Summary
The facility failed to ensure a resident’s right to formulate an advance directive was fully honored when a Do Not Resuscitate (DNR) order was not properly executed. The resident was an elderly male with a history of cerebral infarction, frontal lobe and executive function deficit following cerebral infarction, and Parkinson’s disease without dyskinesia. His face sheet identified him as DNR, his quarterly MDS showed a Brief Interview for Mental Status (BIMS) score of 2/15 indicating severe cognitive impairment, and his care plan documented his choice of DNR status with a directive not to provide CPR. Active physician orders also included a DNR order. The clinical record contained a Texas Out-of-Hospital DNR document signed and dated by the resident’s representative and the physician. However, the DNR document’s “Two Witnesses” section contained two witness signatures that were not dated, meaning the form was not fully and properly completed. During interviews, the MDS RN, who stated she was responsible for verifying DNR document accuracy, acknowledged that the witness signatures were not dated and could not explain how verification occurred without those dates. An LVN stated that a DNR would not be valid if witness signatures were not dated and identified that the MDS RN and DON were responsible for ensuring DNR documents were correct. The DON also confirmed the DNR was not correct due to the missing witness dates and stated that she and the MDS RN were responsible for ensuring DNR documents were accurate. A blank Texas Out-of-Hospital DNR form reviewed by surveyors specified that only a fully and properly completed DNR order is sufficient evidence to be honored by health care professionals.
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