HospitalInspections.org

Based on a review of the Policy and Procedure, Clinical Record reviews, and staff interviews.
It was determined that the facility failed to exercise patient/ family's rights concerning end-of-life decisions and failed to give the family information to make an informed decision regarding end of life decision for one of three patients reviewed (Patient #1).

Findings included:

Review of the facility policy, "Do Not Resuscitate (DNR)", Policy # ADMIN.RI.006.600, Revision: 09/2019, states that all persons will be given lifesaving treatment (cardio-Pulmonary Resuscitation, CPR) unless there is a physician order to withhold lifesaving treatment. Do Not Resuscitate(DNR). If no current orders are documented in the chart to withhold life-sustaining treatment, all persons will be given active (life-sustaining) treatment.
Cardiopulmonary Resuscitation means only those measures used to restore or support cardiac or respiratory function in the event of cardiac or respiratory arrest. Cardiopulmonary Resuscitation includes any stimulation, massage pumping action to the heart by manual, mechanical, pharmaceutical or electric means; and/ or the assistance to respiration by oral (mouth to mouth) or mechanical means.
A review of the medical record for Patient #1 revealed that the Patient was full code. Patient #1 was admitted on 05/27/20 for fall. On 05/28/20 Patient #1 had surgery on left displaced periprosthetic and femur fracture. On 05/30/20 at 2:01 PM, the Physician progress note showed that the Patient had altered mental status and was on respiratory support (BiPAP: non-invasive ventilation is used of breathing support administer n through a face mask or nasal mask). The family expressed that they only wanted the Patient to have medication coding and intubation (Placing a tube in your throat to help move air in and out of your lungs. Mechanical ventilation is the use of a machine to move air in and out of the lungs). They did not want the Patient to have any further chest compression and Defibrillation ( a process in which an electronic device sends an electric shock to the heart). The family informed the Physician of their wishes before and after the Patient was given CPR. On 05/30/20 at 2:20 PM a Nursing note reflected that during catheter placement for dialysis, the Patient went Asystole (cardiac arrest in which the heart stops beating). Compression started, and medication administered. The family stated the Patient isn't to receive CPR or Defib. On 05/31/2020 at 12:36 AM, Death event note: The Patient placed on hemodialysis on May 30th. The family declined an exploratory lap to rule out any intra-abdominal bleeding and also rejected any heroic intervention such as chest compression. The Patient pronounced at 05/31/2020 12:36 AM.
An interview on 06/05/2020 at 12:20 PM with the Patient Safety Director and the Director of Quality confirmed that the rights of the Patient and next of kin were not honored and the physician did not explain to the family that the facility only has DNR or full code. Per the Director of Quality, the physician is new to the facility.