The resident has the right to and the facility must promote and facilitate resident self-determination through support of resident choice, including but not limited to the rights specified in paragraphs (f)(1) through (11) of this section.
§483.10(f)(1) The resident has a right to choose activities, schedules (including sleeping and waking times), health care and providers of health care services consistent with his or her interests, assessments, and plan of care and other applicable provisions of this part.
§483.10(f)(2) The resident has a right to make choices about aspects of his or her life in the facility that are significant to the resident.
§483.10(f)(3) The resident has a right to interact with members of the community and participate in community activities both inside and outside the facility.
§483.10(f)(8) The resident has a right to participate in other activities, including social, religious, and community activities that do not interfere with the rights of other residents in the facility.
Based on clinical record reviews and staff interviews, it was determined that the facility failed to ensure that residents' healthcare choices were promoted by failing to note the correct information regarding cardiopulmonary resuscitation for one of 14 residents reviewed (Resident 2).
A quarterly Minimum Data Set (MDS) assessment (a mandated assessment of a resident's abilities and care needs) for Resident 2, dated February 2, 2020, revealed that the resident had moderate cognitive impairment, could understand, and could be understood by others. A Pennsylvania Orders for Life-Sustaining Treatment (POLST - a form that contains documentation of the resident's or the legal representative's choices regarding life-sustaining treatment, including if cardiopulmonary resuscitation (CPR) should be performed for a person who has no pulse and is not breathing), dated January 31, 2020, indicated that the resident was not to be resuscitated (DNR - Do Not Resuscitate), indicating that the CPR was not to be performed. The POLST form was signed by the resident's power of attorney (a person who is legally authorized to make decisions on the behalf of a person who can no longer make their own decisions) and was signed by the physician on January 31, 2020.
A summary of physician's orders, signed by the physician on February 11, 2020, indicated that the resident was to have CPR performed in the event that she had no pulse and was not breathing, and the dashboard section of the resident's electronic health record (contains basic identification information and the resident's CPR status) also indicated that CPR was to be performed.
Interview with Registered Nurse 1 on February 25, 2020, at 8:52 a.m. confirmed that Resident 2's clinical record indicated that CPR was to be performed.
Interview with the Director of Nursing on February 25, 2020, at 8:58 a.m. confirmed that the physician's order in Resident 2's clinical record was not correct, and the resident should have had a physician's order for DNR in accordance with the POLST.
28 Pa. Code 201.29(j) Resident rights.
28 Pa. Code 211.5(f) Clinical records.
28 Pa. Code 211.12(d)(3)(5) Nursing services.
| ||Plan of Correction - To be completed: 03/24/2020|
R2 POLST (Pennsylvania Orders for Life-Sustaining Treatment) was reviewed and updated to reflect current order. Resident remains in facility in stable condition.
Audit of current residents have been completed to ensure healthcare choices are current related to Code Status and Physician orders. Licensed staff will be re-educated on obtaining POLST(Pennsylvania Orders for Life-Sustaining Treatment) signatures and updating change when they occur.
To prevent this practice from re-occurring POLST (Pennsylvania Orders for Life-Sustaining Treatment) will be reviewed for completion upon admission to ensure family and physician signatures are present on POLST (Pennsylvania Orders for Life-Sustaining Treatment) and orders will be reviewed to ensure both are accurate and updated in Electronic medical record system. A review of the POLST( Pennsylvania Orders for Life-Sustaining Treatment)will be part of the Care plans review process and updated accordingly with each care plan review.
Audits will be completed daily by Director of Nursing/Designee daily times 30 days, weekly times 2 weeks and Monthly. Audit results will be reviewed with Quality Assurance committee for recommendations. Root cause analysis has been completed.
In preparation and/or execution of this plan of correction does not constitute admission or agreement by the provider of the truth of the facts alleged or conclusions set forth in the statement of deficiencies. The plan of correction is prepared and/or executed solely because it is required by the provisions of federal and state law.