Failure to perform Cardio-Pulmonary Resuscitation (CPR) for residents when their condition and medical record documentation warrant it could be considered neglect and a violation of residents’rights, resulting in substandard quality of care and potential fraudulent billing
Compliance Perspective – CPR Negligence
Policies/Procedures: The Compliance and Ethics Officer with the Administrator will review policies and procedures regarding advance directives entered into a resident’s medical records by the resident or their responsible party.
Training: The Compliance and Ethics Officer with the Director of Nursing will ensure that staff are trained to understand the policies and procedures regarding advance directives, and how to proceed in performing CPR in a timely manner when it is indicated.
Audit: The Compliance and Ethics Officer with the Director of Nursing will conduct mock drills using multiple types of scenarios and advanced directives with staff to test their ability to respond appropriately and in a timely manner.
An investigation by the Minnesota Health Department (MHD) into the death of a nursing home resident determined the death to be the result of neglect due to the nursing home staff’s failure to initiate CPR. The resident was severely impaired cognitively, considered a high risk for falls, and was to be monitored every 15 minutes. The resident had a CPR request on file.
Previously, the resident was found sliding out of a wheelchair, suffered no injuries, and was put to bed. Later that evening,the resident called out, but when the staff checked, the resident was sleeping.Thirty minutes later, when staff returned to take vital signs, the resident was struggling to breathe. The nurse left the room to check the resident’s chart and noted that the resident should have CPR, so the nurse called 911. Before she could finish the call, the nurse was called back to the resident’s room. Staff were attempting to place an oxygen mask on the resident, but stopped when the nurse found the resident had no pulse and was not breathing. At that point the resident was found to be deceased. When the 911 dispatcher called back, the nurse indicated that no ambulance was needed. The cause of death was attributed to sudden cardiac arrest.
The MDH report indicated that “not all staff were knowledgeable about the nursing home’s policies and procedures on CPR and advance directives.” The MDH also found this statement in the nursing home’s policy: “CPR will not be performed if a death is unwitnessed and more than five minutes has passed since the resident was last witnessed alive.” Since theincident, the nursing home reports that it has changed its CPR protocols, andstaff have been retrained.
