HospitalInspections.org

Based on facility document review and staff interviews, it was determined the facility failed to comply with the patient's and the patient surrogate's refusal for life-prolonging procedures in 1 of 10 sampled patients (Patient #4).

The findings included:

On 10/26/2017, Patient #4 presented to the emergency department with weakness, shortness of breath, and diarrhea.

The patient had diagnoses to include Congestive Heart Failure.

The record revealed the patient had an advance directive and a healthcare surrogate, which he gave to the hospital to place in his medical record. The patient was admitted and elected to have full resuscitation.

The patient's condition declined and the healthcare surrogate began to make decisions for him.

Record review on 10/30/2017 at 10:18 AM, the cardiologist resident ordered a Do Not Resuscitate for the patient at the healthcare surrogate's request. This order was electronically signed by a Resident Physician.

At 7:52 PM, the attending physician saw the patient and the healthcare surrogate, at the patient's bedside. The record revealed, the patient's condition was guarded and the physician recommended the patient be placed at a nursing facility once the patient leaves the hospital as the patient had deteriorated from baseline. At 10:32 PM, a code blue was called. Cardio Pulmonary Resuscitation was started.

At 10:34 PM, the resuscitation record revealed the patient was shocked 6 times.

At 10:43 PM, the patient was intubated and the code ended.

At 11:10 PM, the patient was transferred to the intensive care unit. Another code blue was called. The resuscitation record revealed the patient was shocked 4 times.

At 11:34 PM, the code was stopped and the patient was pronounced dead.

on 12/01/17 at 11:37 AM, the attending physician dictated the discharge summary that revealed that on 10/30/17, the patient was evaluated at the bedside with myself and a family member, who was the healthcare surrogate. "Apparently, the patient's family member had informed the cardiologist resident that patient was a Do Not Resuscitate after the patient was admitted to the intensive care unit."

Review of the policy and procedure regarding the Allow Natural Death and Adults Policy and Procedure includes, "a written medical order prepared by the primary physician that documents instruction by a patient with decision-making capacity, or if the patient is incapacitated, by a person with legal authority to make health care decision on behalf of the patient, that in the event the patient suffers a cardiac and/or a respiratory arrest; cardio-pulmonary resuscitation is to be withheld."

Review of the Do Not Attempt Resuscitate (DNAR) Status, Identification of Adult Patients Policy and Procedure includes, "All patients admitted to the hospital who have an active DNAR order must have a purple with a white dove identification bracelet."

The Director of Quality and Patient Safety, Risk Management Specialist, and the Director of Adult Care, agreed that patient #4 had a health care surrogate, and on 10/30/17, a resident wrote an order for a Do Not Resuscitate per the healthcare surrogates request, the order was noted by a nurse, the nurse failed to notify the primary care physician so he could cancel the full resuscitation order and order the Do Not Resuscitate, and the nurse failed to place a purple armband on the patient to signify the patient was a Do Not Resuscitate. They confirmed a code blue was called later that evening and the patient was resuscitated.