Publications: Ask The Legal Expert - May 2006

What are policy essentials for avoiding monetary penalties regarding "do not resuscitate" orders?

Facilities use different procedures to distinguish between DNR and "full code" residents. No doubt, some have proved inadequate. Every DNR policy should set forth a clear, unequivocal and rapid procedure for determining a resident's CPR status.

The effectiveness of CPR depends on rapid response, which allows no time to leaf through a medical record to determine a resident's status before beginning CPR.

At a minimum, facilities should (1) determine a resident's DNR preference at or near the time of admission - before an emergency arises; (2) ensure each resident's records clearly and consistently document his or her CPR status and (3) effectively communicate that status to staff members.

In one CMS hearing, a surveyor noted that putting in place a sticker system to easily identify residents with DNR orders can help bring a facility into compliance.

Moreover, facilities must routinely inservice its staff on what a DNR order means. They are often misconstrued to indicate more than "do not attempt CPR." For example, DNR may be misconstrued to imply limitations on treatments, such as not performing a Heimlich maneuver on a choking resident. Administrative personnel should familiarize themselves with state laws on advance directives, resuscitation, decisions and the determination of death.

Reproduced with permission from McKnight's Long-Term Care News

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