HospitalInspections.org

Based on record review and staff interview it was determined that the facility failed to comply with the patient's advance directives for one (#1) of three patients sampled. This practice does not provide for the implementation of the chosen advanced directive.

Findings include:

Patient #1's History and Physical dated 1/31/10 stated
the patient was admitted with a diagnosis of acute respiratory failure and was intubated prior to admission. Review of the nursing admission assessment revealed the emergency notification was listed with the POA ' s (Power of Attorney) name and phone number. The assessment revealed the patient had a Durable Power of Attorney designating an adult child for medical care and a copy was available in the medical record. Review of the Care Management notes revealed the care manager spoke with the POA on 2/01/10 and confirmed the patient's POA documentation. The documentation noted the care manager spoke with the POA and the patient was to be a full code.

On 2/05/10 at 11:37 a.m. documentation revealed the patient went into cardiac arrest and emergency resuscitation was started. Review of the resuscitation form revealed CPR (cardiopulmonary resuscitation) was started at 11:37 a.m. and Epinephrine and Atropine were administered. Review of the physician's progress note revealed that efforts were stopped upon request of the spouse, who was at the bedside. The efforts were stopped at 10:41 a.m.

A physician present at the code was interviewed on 2/25/10 at 2:00 p.m. The physician stated he responded to the code on 2/05/10 at approximately 11:38 a.m. The physician stated he was familiar with the patient and was one of the physician's treating the patient during that
admission. The physician stated a family member identified the patient's spouse to be at the
bedside. The physician stated he stepped out of
the room and spoke with the patient's spouse about the patient's condition. At that time the spouse told the physician to let the patient die in peace.