HospitalInspections.org

Based on observation, staff interviews, and policy review, it was determined the facility failed to follow and implement their policy related to the patient's right to formulate advanced directives and Do Not Resuscitate (DNR) orders for two (#11, #12) of five patient's observed of twelve patients sampled.

Findings included:

On 04/14/17 at approximately 08:50 AM, a tour was conducted of the Medical/Surgical Unit, located on the third floor, accompanied by the Director of Clinical Services. Interviews with unit staff, while touring, revealed the following response related to the color of the patient DNR armband:

Staff RN #J stated the armband color is yellow.
Staff RN #K stated the armband color is purple.
Staff RN #T stated the armband color is purple.
Staff CNA #L stated the armband color was either green or purple.
Staff RT #M stated the armband color is purple.
Staff RN #N stated that sometimes the patients have a DNR band and it is yellow.
Staff RN #O stated the armband color is purple.
Staff RN #S stated she did not know what the purple armband meant that was on her patient in room 315 bed A and had to look to see what it said.
Staff CNA #P stated the armband color is purple.
Staff Respiratory Therapist (RT) #Q stated the armband is purple.
Staff RN #R stated the armband color is purple.
Nursing Supervisor #E stated there are no patient armbands for DNR status.

On 04/14/17 at approximately 11:00 AM, an interview conducted with the Senior Director of Clinical Services revealed the corporate policy is to not use armbands to designate DNR status. She further stated, "staff at this facility are apparently confused and are continuing to use the purple armbands."

In total, 9 staff members thought the DNR armband was purple, 2 staff thought the DNR armband was yellow, one staff member thought the DNR armband was green, and one nursing supervisor thought there were no DNR armbands.

While on tour, 5 patients with a designated DNR status were checked for the presence of a DNR armband. Findings revealed 2 patients (#11 and #12) had purple armbands on indicating DNR.

On 04/14/17 at approximately 11:05 AM, review of the facility policy entitled, Advanced Directives, #H-PC 08-001, and released 06/16, revealed the following definitions:
Advanced Directives are the written or oral instructions communicating the health care treatment wishes of an adult, in the event the adult becomes incapacitated. These instructions include but are not limited to a living will, designation of a healthcare proxy or durable power of attorney for healthcare, or consent for order to withhold resuscitation efforts (DNR).
1. No CPR/NO Code/Do not Resuscitate (DNR) Order - these designations mean specifically that IF cardiac and/or respiratory arrest occurs, cardio pulmonary resuscitation (CPR) will not be performed.
Review of the facility policy entitled, Code Status Classification, #H-PC 08-002, and a release date 06/2016, revealed the following:
1. Patients are asked about code status and their preferences regarding life-sustaining treatment at admission.
2. There shall be two categories of Code Status ...for patient resuscitation (Yes and No) ...patients are provided resuscitation services unless precluded by a legal advance directive and physician's order ...the primary reference point for Code Status classification is the electronic medical record.
The facility policies related to code status made no reference to the application of patient armbands for code status.

An interview conducted on 04/1/4/17 at approximately 11:00 AM with Senior Director of Clinical Services, confirmed the above findings.