End of life decisions are an obvious personal decision. Whatever the individuals decision to use or withhold lifesaving measures, the individuals decision should be respected and followed by the facility. In medical emergencies where time is of the essence, it may not be practical for nursing home or hospital staff to carefully review the contents of the residents chart to make the determination in providing these life-extending treatments.
Following a series of cases where life-saving procedure were carried out against resident wishes and in other situations where life saving measures were withheld from residents who wished to resuscitated, Kentucky officials are considering a new law to help ensure the residents wishes were followed. A purple wristband worn by residents would alert staff that the resident executed a ‘do-not-resuscitate’ or ‘DNR’ order.
Kentucky, like many states, has no formal regulation regarding how to inform staff or DNR orders in nursing homes or hospitals. This new proposal follows the publicized confusion related to residents’ end of life decisions.
As reported in the Lexington Herald-Leader, the the confusion has resulted in fines against facilities for their errors:
- Kenton Healthcare in Lexington was cited in September 2007 after the staff allegedly did not initiate lifesaving measures on a resident despite a doctor’s orders that everything possible be done to save the patient.
- Hillcrest Health Care Center in Owensboro was cited in December 2008 after cardiovascular pulmonary resuscitation was not performed on a resident who wanted to be resuscitated.
- In April 2007, staff members at Christian Health Center in Bowling Green did not immediately resuscitate a resident, despite a doctor’s orders that lifesaving measures should be used.Staff members told state investigators that the facility did not have a system that allowed immediate access to the code status of a resident.
- Woodland Oaks Nursing Home in Ashland is appealing a citation it received in January. Officials there deny failing to perform CPR on a dying patient who had requested lifesaving measures.
- Green Meadows Health Care in Mount Washington received a citation in March 2008 for trying to revive a resident who had signed a DNR order.
- In March, Jefferson Manor in Louisville was cited after 95-year-old Eva Karem was resuscitated in February 2008 despite a DNR order. (It received a citation that was not as serious as a Type A.)
Nursing home and hospital officials will meet in the next few weeks to determine if the ‘purple bracelet’ program is feasible. Although the program would not likely apply to hospitals, the Kentucky Hospital Association is considering a similar color-coded wristband system to help alert staff to residents’ with allergies or who may be at high risk for falls.
I’m all for such a safeguard system with respect to DNR orders, allergies and falls. We live in an era where many facilities are chronically short-staffed and high staff turn-over is the norm, anything that can both improve patient care and reduce the work-load of staff should certainly be given top consideration.
For laws related to Kentucky nursing homes, look here.
A ‘Do-Not-Resuscitate Order’ (most commonly referred to as a ‘DNR’ order) is a medical treatment order stating that cardiopulmonary resuscitation (CPR) will not be attempted if your heart and/or breathing stops.
In addition to properly executing the legal document, it is also important to inform your family, physicians, and your attorney of your decision to make one or more advance directives or a DNR order. If your family is aware of your advance directives / DNR orders, it will be easier for them to follow your wishes at a time when you may be unable to communicate them. If you cancel or change an advance directive or a DNR order in the future, remember to tell these same people about the change or cancellation.
All hospitals, long-term care facilities and nursing homes must follow your advance directive decisions. It is entirely your decision. If a health-care facility, health-care professional or insurer objects to following your advance directive or DNR order then they must tell you or the individual responsible for making your health-care decisions. They must continue to provide care until you or your decision maker can transfer you to another health-care provider who will follow your advance directive or DNR order.