Staff Withheld CPR from Two Nursing Home Residents Who Died
Two Missouri nursing home residents died one week apart after staff elected not to perform CPR although the residents did not have “do not resuscitate” advance directives advising such action. The deaths triggered an investigation by the Centers for Medicare & Medicaid Services (CMS) regulators.
Following its investigation, CMS issued a statement about deficiencies that outlined a number of problems with the nursing home, but were mainly focused on the care of the two residents who died. Residents in the nursing home were determined by CMS to be in “imminent danger” and the facility was ordered to take immediate corrective measures.
The two deaths were described as “unexpected,” and one of the two had been in the nursing home for rehabilitation only and anticipated returning home at some point. The report noted failures by the nursing staff in following physicians’ orders regarding administering treatments, medications, and a lack of knowledge about which residents should receive life-saving CPR.
The nursing home has been allowed to remain open and operating after ensuring authorities that there are policies and procedures in place to prevent similar events and mistakes from occurring in the future. Investigators will follow-up as indicated by the facility’s “plan of correction” to ensure that there have been no further issues.
Compliance Perspective
Failure by nursing staff to perform CPR for residents who have not selected “Do Not Resuscitate” status may be considered substandard quality of care with potential for immediate jeopardy, in violation of state and federal regulations.
Discussion Points:
- Review policies and procedures regarding protocols for performing CPR or other advance directives and following physicians’ orders for treatments and medications
- Train staff to know all residents’ advance directive status, and that if the resident does not have a specific “do not resuscitate” advance directive, staff must perform CPR when vital signs are not present.
- Periodically audit to determine if advance directives are noted on residents’ care plans and agree with physician orders. Consider having periodic drills to ensure that nursing staff are aware of residents’ advance directives (e.g., DNI, DNR, and DNH). Also audit to determine that staff members are current with their CPR certification.
