HospitalInspections.org

Based on staff interview, policy review, and medical record review it was determined the registered nurse failed to ensure that the policy and procedure was followed for Do Not Resuscitate Comfort Care and Code Blue Orders.(A396) The cumulative effect of this systemic practice resulted in the facility's inability to ensure that the patient's nursing needs would be met.

Based on staff interview, policy review, and medical record review it was determined the registered nurse failed to ensure that the policy and procedure was followed for Do Not Resuscitate Comfort Care and Code Blue Orders (DNRCC-Arrest). This affected one patient ( Patient #8) out of ten medical records reviewed. The total active census at the time of the survey was 203 patients.

Findings include:

The medical record review for Patient # 8 was completed on 02/20/14 at 2:15 PM. The medical record revealed the patient was transferred by squad from a nursing home and/or other facility to the emergency department on 12/27/13 at 11:06 AM. The patient was admitted and transferred to the intensive care unit on 12/27/13 at 4:10 PM as a full code. Nursing documentation on 12/27/13 at 6:10 PM revealed the daughter stated she is the power of attorney (POA) and that the patient was a DNRCC-Arrest code. A DNRCC-Arrest order was signed by the physician and by the daughter on 12/27/13 while the patient was admitted to the intensive care unit.

Review of the hospital's policyon 02/19/14 at 2:45 PM, titled "DO NOT RESUSCITATE (DNR) COMFORT CARE AND CODE BLUE ORDERS, effective 07/01/11, defined do not resuscitate comfort care - arrest (DNRCC-Arrest) as "...is implemented once the patient experiences cardiac arrest or respiratory arrest...upon cardiac arrest or respiratory arrest all treatement is withdrawn..."

The patient was transferred to the medical surgical unit on 12/29/13 at 4:30 PM with DNRCC-Arrest orders. On 12/30/13 at 11:31PM a code blue was called and cardiopulmonary resuscitation initiated. Epinephrine was administered on 12/30/13 at 11:37 PM with compressions. Nursing documentation revealed a bedside chest x-ray confirmed the placement of the endotracheal tube on 12/31/13 at 12:00 AM.

Interview with Staff F on 02/20/14 at 11:30 AM indicated that during the code blue event the daughter of the patient was notified by phone and she stated the patient was a DNRCC-Arrest. It was determined the patient was a DNRCC-Arrest and the patient was transferred to the intensive care unit on life support with DNRCC-Arrest papers in the front of the medical record on 12/30/13 at 11:59 PM.

Interview with Staff F on 02/20/13 at 11:30 AM revealed the medical surgical shift nurse reported she did not receive the code status of the patient during shift report and the medical record lacked evidence of a green dot to identify the code status of the patient. Multiple physicians' documented the patient was a DNRCC-Arrest and cardiopulmonary resuscitation was intiated. Risk management was notified and the patient was removed from life support and expired on 12/31/13 at 2:22 AM.

Staff B stated in an interview on 02/20/14 at 9:10 AM that the medical surgical unit uses a green dot system on the spine of the medical record to identify a patient's code status, however this is not consistent between nursing units.

Staff A reported the facility use of arm bands to identify a code status is on the meeting agenda set for March 2014. Staff A stated the arm band identifier is not currently being utilized due to the difficulty of obtaining the product, however this has been the preferred method for inpatients and outpatients per policy.

The hospital's policy and procedure titled "DO NOT RESUSCITATE (DNR) COMFORT CARE AND CODE BLUE ORDERS" was reviewed 02/19/14 at 2:45 PM. The policy included acceptable forms of identification for patient's with (DNRCC) orders. The policy revealed (DNRCC) identification will be reviewed during each admission. All (DNRCC) orders will be written in the physician's orders. Other forms of identification include a transparent type bracelet, necklace, and a wallet card for code status.