HospitalInspections.org

Based on policy and procedure review, open medical record review, observation, patient and staff interview, the facility's nursing staff failed to ensure DNR (Do Not Resuscitate) armbands were applied according to policy for 2 of 6 sampled patients with DNR orders (#9, #11).

The findings include:

Review of policy and procedure on 11/01/2016 titled "ADVANCE DIRECTIVES" effective date: 07/18/2015 revealed "..c. Identification of DNR Patients: The patient's header in Epic (Electronic medical record) will list the patient's code status; if no code status is noted in the header, the patient is a full code. All patients with a "Do Not Resuscitate" order on the chart will have a purple armband applied designating, "DNR.".... "
1. Medical record review on 11/01/2016 revealed an 87 year old female, Patient #9, presented to the ED (Emergency Department) on 10/26/2016 at 1351 with the following: increased confusion, headache and left lower hemiparesis (muscular weakness or partial paralysis). The patient was admitted to an inpatient unit with a diagnosis of Subdural Hematoma (blood clot on the brain). Further review revealed the patient had a Craniotomy (surgical procedure to remove blood clot on the brain) performed on 10/27/2016. Review of Physician's orders revealed an order for DNR (Do Not Resuscitate) status. The Epic header indicated Code status as DNR.
Observation of the 5B Neuro Unit on 11/01/2016 at 1435 revealed Patient #9 did not have a purple armband on, indicating she was a DNR patient.
Interview on 11/01/2016 at 1435 with Patient #9 revealed, "They know I am a DNR. I had one on the last time I was here."
Interview on 11/01/2016 at 1500 with RN #1 (Registered Nurse caring for the patient during the morning shift) revealed that today was her first time taking care of the patient. Interview revealed she knew Patient #9 was DNR status. She noted the DNR status on the chart earlier that morning. Interview revealed RN intended to put a purple bracelet on the patient.
2. Medical review on 11/02/2016 at 1535 revealed that patient #11 was admitted as
an inpatient on 11/01/2016 at 0846 with the principal problem being unresponsive. Review
revealed an order for DNR (Do Not Resuscitate) status on 11/01/2016 at 1630. Continued
review revealed the Epic header indicated Code status as DNR.

Observation of the CVIU (Cardiovascular Intermediate Unit) 3E on 11/02/2016 at 1535
revealed Patient #11 did not have a purple armband on indicating she was a DNR status
patient.

Interview on 11/02/2016 at 1535 with AS #2 (administrative staff) acknowledged there was
not a purple armband applied to Patient #11 and the policy was not followed.

NC00120858