HospitalInspections.org

Based on staff interview and document review, it was determined the facility failed to ensure each patient had the right to formulate advanced directives and the facility failed to comply with these directives. Specifically, hospital staff failed to ensure information related to code status was documented and communicated to transportation providers at the time time of discharge from the hospital to ensure patient's wishes related to life prolonging procedures were upheld in one (1) of five (5) medical records reviewed in the survey sample. Medical record #1.

Findings:

The medical record for patient #1 contained documentation that the patient was a 67-year-old female with a history of severe dementia, mood disorder, and end stage renal disease who was seen in the emergency department after nursing home staff reported that the patient was agitated, yelling out, and hitting and kicking staff. The patient was admitted to the hospital 9/28/22.

The medical record for patient #1 contained documentation that the patient had a physician's "Do Not Resuscitate"(DNR) order while in the hospital. The patient's discharge code status in the discharge summary prepared by the nurse practitioner was documented as "DNR - allow natural death."

The medical record contained documentation of a scanned copy of a Durable Do Not Resuscitate Order (DDNR) dated 09/28/22 and signed by the patient's family member (person authorized to sign on behalf of the patient). The physician signature line on the form was blank.

The medical record contained documentation that the patient was discharged home with hospice on 10/03/22. The patient was transported by private ambulance home. The medical record contained no documentation that a DDNR signed by the physician was sent with the transportation company to the patient's home.

An interview was conducted with the Director of Case Management (staff member #7) at 2:30 PM on 02/27/23. Staff member #7 confirmed the medical record for patient #1 did not contain a signed DDNR or documentation that a signed DDNR was sent with patient transport. Staff member #7 confirmed that if the patient had experienced cardiac or respiratory arrest during transport home, the transport company would have likely provided CPR (cardio-pulmonary resuscitation) and/or life prolonging measures that were contrary to patient's #1's documented wishes to withhold life-prolonging procedures. Staff member #7 confirmed that the hospice company typically assists with obtaining a physician signature for the DDNR, but patient #1 lived in a different location and the hospice company selected at discharge was not one that frequently worked with the hospital.

The facility policies, Code Status Identification and Advanced Medical Directives were reviewed, but did not contain information related to communication or documentation of code status to the transportation company at discharge. The facility's, Patient Rights and Responsibilities document was reviewed and partially reads as follows, "Your Rights...You have the right to...have your culture, values, beliefs and preferences respected...help decide the plan for your care, take part in your care as desired, make advanced directives, have your medical and end of life care wishes followed and conflicts addressed."