| 4056 |
PRUITTHEALTH-BLYTHEWOOD |
425400 |
1075 HEATHER GREEN DRIVE |
COLUMBIA |
SC |
29229 |
2017-09-15 |
490 |
J |
1 |
1 |
4HVH11 |
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on full and/or limited record reviews, interviews and review of the facility policies, the facility administration failed to ensure appropriate polices and procedures were developed and implemented to identify if Advanced Directives were formulated and proper care and services were provided related to cardiopulmonary resuscitation for 2 of 3 sampled residents reviewed for death in the facility. The failure of the facility to ensure policies and procedures were established and implemented according to State law regarding Advanced Directives placed all residents at risk for serious harm/death. CFR 4[AGE].[AGE] F-490 Administration was identified at a scope and severity level of (J). It was determined that Immediate Jeopardy existed on [DATE] for Resident #205 and on [DATE] for Resident #210 when licensed nursing staff failed to provide cardiopulmonary resuscitation (CPR). The facility failed to establish and implement policies and procedures consistent with State law regarding health care decisions/formulation of advance directives. The facility transferred decision-making responsibility to the legal representatives of Residents #205 and #210 without two physicians' determinations of the residents' inability to make health care decisions. The findings included: Cross Refer to CFR 4[AGE].10(b)(4) F-155 Right to Formulate an Advance Directive was identified at a scope and severity level of (J). The facility transferred decision-making responsibility to the representatives of Residents #205 and #210 without two physicians' determinations of the residents' inability to make health care decisions. This failure resulted in staff not initiating cardiopulmonary resuscitation (CPR) as required. Cross Refer to CFR 4[AGE].25 F-309 Provision of Care and Services was identified at a scope and severity level of (J). The Immediate Jeopardy existed on [DATE] for Resident #205 and on [DATE] for Resident #210 when licensed nursing staff failed to provide the necessary care and services when the residents exhibited absence of vital signs and did not receive cardiopulmonary resuscitation (CPR). Cross Refer CFR 4[AGE].[AGE](o)(1) F-520 Quality Assurance was identified at a scope and severity level of (J). The facility failed to ensure the Quality Assurance process was utilized to identify, and implement a plan of action regarding adherence to legally executed Advanced Directives. The facility Administration failed to ensure appropriate policies and procedures were developed in accordance with State Law and implemented to identify and clarify Advance Directives, to ensure residents were provided appropriate services related to Advance Directives and provision of care consistent with those directives, and to ensure the Quality Assurance process was utilized to identify, clarify, and implement a plan of action related to such. The [STATE] Code of Laws, TITLE 44. HEALTH, CHAPTER 66. Adult Health Care Consent Act notes persons who may make health care decisions for a patient who is unable to consent in order of priority. SECTION [DATE]. Definitions states: (8) Unable to consent means unable to appreciate the nature and implications of the patient's condition and proposed health care, to make a reasoned decision concerning the proposed health care, or to communicate that decision in an unambiguous manner. A patient's inability to consent must be certified by two licensed physicians, each of whom has examined the patient. Review of the facility policy titled Do Not Resuscitate Policy: [STATE] and the [STATE] Code of Laws, TITLE 44. HEALTH, CHAPTER 66. Adult Health Care Consent Act revealed the policy was not in conformance with State law. The [DATE] policy stated: Definitions: 4. Decision Making Capacity.Every adult is presumed to have decision making capacity unless determined otherwise by a physician in writing.Procedure: I. Receiving a DNR Order from Another Healthcare Provider: A. Any written order issued by any attending physician using the term 'do not resuscitate', 'DNR',.or substantially similar language, and that is contained in the patient's medical record shall constitute a sufficient order.C. If an adult patient/resident does not have decision-making capacity and is a candidate for non-resuscitation a physician may issue a DNR with the consent of the patient/resident's representative. The facility Administrator was informed of the Immediate Jeopardy on [DATE] at 12:40 PM. The facility provided an Allegation of Compliance (AOC) that was acceptable and noted to be implemented on [DATE]. The Immediate Jeopardy at F-155, F-309, F-490, and F-520 was removed on [DATE] but the citations remained at a lowered scope and severity of D. The AOC included the following: (1) The residents with the alleged deficient practice are no longer residing in the facility. (2) The Director of Health Services will complete a review of all residents in the facility to ensure that do not resuscitate orders have been obtained per policy and state regulations. The Social Worker will also ensure where appropriate two physician signatures have been obtained. (3) All new residents ' code status will be included on the 24 hour chart check daily and then reviewed during the daily morning meeting for compliance. (4) The DNR policy is as follows: Prior to, or upon Admission, the patient/resident and/or their responsible party will be asked about the existence of any advance directives. The Advance Directives Checklist, which is in the South Carolina Admission Packet, will be completed. Should the patient/resident indicate on the Advance Directive Checklist that he/she has issued advanced directives about his/her treatment, the healthcare center will require that copies of such advance directives be given to the healthcare center for inclusion in the patient/resident's medical record. A copy of the advance directive shall become a permanent part of the patient/resident medical record. The Director of Health Services will notify the attending physician of advance directives and document such notification in the medical record. Should the patient/resident indicate on the Advance Directive Checklist that he/she does not currently have an advance directive, but would like further information on advance directives; the patient/resident shall be provided with legal forms located on the [STATE]'s Office on Aging website. If upon admission, or any time thereafter a patient/resident or his Representative requests a DNR order, the Social Worker/Case Mix Director or Director of Health Services shall be responsible for completing the process. If an adult patient/resident HAS decision making capacity, he/she may consent to an order not to resuscitate. If an adult patient/resident does not have decision making capacity and is a candidate for non- resuscitation and the attending physician may decide to withhold life-prolonging measures or discontinue life prolonging measures by initiating a without decision making capacity form and having a concurring physician signature along with the authorized person signature. All resident will be a full code until this procedure is complete (5) The facility Admission Director will review advance directive checklist with resident and or responsible party. If there resident is confused and BI[CONDITION] (Brief Interview for Mental Status) score is 9 or below, a decision making capacity form will be completed with two physician signatures. The BI[CONDITION] score will be completed on the day of admission for all new residents. (6) Social service was educated on the process for obtaining Advance Directive upon admission and change of condition per policy and by regulation, by the Regional Nurse Consultant. All future hires for the department will be trained during the orientation and all of the Social Workers in the facility will be reeducated annually with their evaluation. (7) The Regional Nurse Consultant has educated both physicians at the facility on the DNR and requirements for the second signature. (8) The Clinical Competency Coordinator will educate all of the licensed nursing personnel on the DNR orders and requirements for DNR orders to be valid before the start of their next work shift. |
2020-09-01 |