Flood of bad CPR news raises quality concerns
McKnight's news stories can be a good source of ideas for quality improvement projects, long-term care attorney Janet K. Feldkamp recently told a webcast audience. Looking at our recent items, I'd say the time is ripe to review CPR policies: Three separate stories emerged last week about a variety of problems — and penalties — related to resuscitation.
In one case, a 53-year-old supervising nurse at a facility in Kingston, NY, faces possible jail time for allegedly failing to provide cardiopulmonary resuscitation for a resident.
The incident involved a resident with Alzheimer's and chronic obstructive pulmonary disease, according to a statement released Thursday by New York Attorney General Eric Schneiderman's office. The supervising nurse was in a female resident's room when she stopped breathing, but the RN did not start life-saving measures or instruct any other caregivers present to do so, the charges state. This reportedly went against the wishes of the resident and her family, and it violated the care center's policy that all residents receive CPR unless a do-not-resuscitate order is on file.
After the resident died, the nurse documented that she had not been in the room when the resident stopped breathing, according to the charges. This alleged lie is what landed the nurse in especially hot water. The “willful violation of health laws” is a misdemeanor, but “falsifying business records in the first degree” is a class E felony, Schneiderman's office stated. If convicted, the nurse could spend four years behind bars.
A case out of Florida involves almost the opposite scenario. Health authorities slapped a facility with a $16,000 fine for providing CPR and using a defibrillator on a resident who had a do-not-resuscitate order in place.
When a 75-year-old male resident stopped breathing in the facility's dining room, staff members leapt into action. Only after paramedics had whisked the man to the hospital did a licensed practical nurse find his DNR order. The facility said it has retrained its staff in light of this incident.
The third story involves a nursing home in Norwich, CT. When a resident there was found without vital signs at 5:30 a.m., a nurse began CPR, according to The Hartford Courant. However, a supervising nurse stopped the resuscitation efforts after five minutes, apparently thinking that CPR already had been administered for 15 minutes.
While the resuscitation was underway, no one called 911, despite this being the facility's policy, the Courant reported. Public health records indicated that this lapse occurred because the resident “was found already expired.” The explanation did not fly with regulators, who fined the facility $1,160.
These cases raise some obvious quality assurance questions: Will a caregiver anywhere in the facility — say, the dining room — be able to quickly tell whether a resident has a DNR order on file? Do all relevant staff members know the facility's full policy on CPR, including how long resuscitation efforts are supposed to last and when 911 should be dialed? And perhaps most importantly, how well trained are supervising nurses and other workers in communicating with each other in these types of situations? What questions need to be asked and answered by the various parties, so that it's second-nature to get accurate and necessary information, no matter what time it might be? And how should aides respond if their supervising nurse issues an order that they believe is a “willful violation” of laws or policies?
At least, these are the questions that seem obvious to me. If you work in a facility and understand CPR policies and do-not-resuscitate orders better than I do, no doubt you see other issues at play. And, chances are pretty good that your colleagues might raise still other questions about what went wrong in these situations. So, if you do undertake a CPR-related quality improvement project, get a wide variety of stakeholders on board. This was an important takeaway from the webcast featuring Feldkamp: Involve workers from a variety of disciplines in quality improvement projects, because a problem can have roots in multiple and unexpected places.
For other practical advice, you can check out the full session put together by Feldkamp and Joyce Rutherford Donner, senior education and support specialist at eHealth Data Solutions (and moderated by yours truly). It's free to access, and who knows — their insights just might spare your organization criminal charges or regulatory penalties, not to mention the far more profound costs accrued when a crisis situation is bungled.
Tim Mullaney is McKnight's Senior Staff Writer. Follow him @TimMullaneyLTC.