|LIABILITYlandscape BY LINDA WILLIAMS, RN|
Knowing when to resuscitate
| In 1997 the Health Care Financing Administration (HCFA) issued a statement to long-term care facilities that receive Medicare or Medicaid funds regarding “do not resuscitate” (DNR) policies. In the statement, HCFA warned facilities not to establish and implement a facility-wide DNR policy for its residents, as the right to formulate an advance directive applies to each individual resident, without condition. All certified facilities are required to inform residents of their right to formulate an advance directive. Either the resident or a designated surrogate decision-maker can choose a DNR status, if desired. According to standard-of-care laws in most states, a person is presumed to have consented to resuscitation in the absence of a DNR order.|
Nursing staff members have a duty to honor a resident’s advance directive. Failure to do so-such as resuscitating a resident who has a DNR order-could lead to a battery suit by the resident’s family. A lawsuit also can emerge from the opposite scenario-not initiating resuscitation measures on a full-code resident-as the nursing home mentioned in the following case study found out. Please take the time to review the circumstances surrounding the following case, and make changes as appropriate at your facility.
The following year, as a CNA entered the man’s room to assist him with his daily care, she found him unresponsive with blood seeping from his mouth. She quickly called for a nurse, who summoned other staff members to retrieve the facility’s crash cart and call an ambulance. As the nurse was preparing to administer oxygen to the resident, she could not find the correct tubing to fit the oxygen concentrator. As the staff frantically tried to find an alternative system to deliver oxygen, the resident remained motionless, with no spontaneous respirations or signs of life. When the paramedics arrived, they were surprised to find that cardiopulmonary resuscitation (CPR) had not been initiated. The resident was pronounced dead upon arrival at the hospital minutes later.
The nursing home’s defense attorney asked a physician to serve as an expert witness in the case and provide his opinion regarding the alleged GI bleed. The physician testified that the entry “firm abdomen,” without any other evidence, was not proof of a GI bleed. He further stated there was no evidence the resident had actually died of a GI bleed. Upon record examination, the defense team was able to find an ADL sheet that stated the resident had normal bowel movements one and three days before the incident, implying no sign of obstruction or internal bleeding. A mediation was called for, and the parties agreed to settle the case for $1.65 million.
By heeding these precautionary measures, you can decrease confusion over treatment decisions and better ensure that the wishes of the residents in your facility are fulfilled
|Linda Williams, RN, is a Long-Term Care Risk Manager for the GuideOne Center for Risk Management’s Senior Living Communities Division. She previously served as Director of Nursing in a CCRC and as a nurse consultant for two corporations with numerous long-term care facilities in Iowa. The GuideOne Center for Risk Management is dedicated to helping churches, senior living communities, and schools/colleges safeguard their communities by providing practical and timely training and resources on safety, security, and risk management issues. For more information, contact Williams at (877) 448-4331, ext. 5175, or email@example.com, or visit www.guideonecenter.com. To comment on this article, please send e-mail to firstname.lastname@example.org.|