HospitalInspections.org

Based on review of the medical record, policy and procedures and interviews it was determined the facility failed to comply with the patients' advanced directives for Do Not Resuscitate (DNR) for one (#2) of ten sampled patients. This practice does not ensure patients' rights are implemented.

Findings include:

Patient #2 was admitted to the facility on 08/05/2011 and was discharged on 8/15/2011. Review of the record noted a DNR for no Cardiopulmonary Resuscitation (CPR) and no intubation that was signed on 8/5/11 at 4:48 p.m. Review of the record revealed the daughter was the health care proxy and the health care durable power of attorney (POA). The form revealed the daughter accepted the responsibility by signature and witnessed by two persons dated 08/05/2011 at 4:48 p.m.

Patient #2 was scheduled for a Esophagogastroduodenoscopy (EGD) on 08/08/2011. Review of the anesthesiologist documentation dated 8/8/11 revealed the anesthesia pre-operative/pre-procedure assessment. The assessment documented the patient was a DNR status.

The patient was taken to the endoscopy room at 10:10 a.m. The patient was connected to the cardiac monitor. It was noted the patient was in Atrial Fibrillation with Rapid Ventricular Response/Ventricular Fibrillation. The patient's blood pressure was not measurable for 1-2 minutes. The carotid artery pulse was not palpable. CPR was initiated for 2 minutes. The EGD procedure was canceled and patient was transferred to the post-anesthesia care unit.

Interview with the Director of Quality and the Nurse Manager for a Medical Surgical Unit on 4/6/12 at approximately 1:00 p.m. revealed that DNRs are suspended during surgical procedures. They stated they thought patients were informed of this in the "Patient Rights" brochure.

A review of the facility's Patient Rights brochure, as provided to the patient upon admission, stated the patient's advance directives will be honored by the staff, the patient/patient health care proxy was encouraged to participate in the plan of care and to receive complete information in order to make informed decisions regarding medical treatment.

Review of Policy and Procedure "Advanced Directives" #200.353 dated 4/11 revealed unless documented by the physician, advanced directives will be suspended during surgical procedures or other interventional procedures with moderate to deep sedation for all patients and will automatically be reinstated when the patient leaves the area.

Random patient interview on 4/6/12 at approximately 1:20 p.m. revealed he had not been informed of the suspension of a DNR status during surgery.

Documentation and interviews revealed the facility failed to honor patients' advance directives by failing to notify patients/legal representatives that the DNR status was suspended during surgical or interventional procedures requiring moderate to deep sedation.