Resuscitation orders not always followed

Published 10:04 am Tuesday, March 24, 2009

LEXINGTON, Ky. (AP) — The question of whether to resuscitate a dying patient is supposed to be resolved by checking the patient’s orders.

But the Lexington Herald-Leader reported Sunday that a gap in Kentucky law has lead to errors at the bedside of the dying.

Sadiqa Reynolds, inspector general for the state Cabinet for Health and Family Services, said there is no uniform regulation for denoting a patient’s wishes regarding resuscitation in a long-term care facility or a hospital.

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That leads to problems such as an incident at Woodland Oaks Healthcare Center in Ashland, Ky., on Christmas Eve. A state citation alleges that the center failed to perform CPR on a dying resident, even though the resident had signed an order asking for resuscitation.

Or the opposite problem, which occurred in February 2008, when John Karem arrived at Jefferson Manor Nursing Home in Louisville to find an emergency medical technician performing CPR on his 95-year-old mother, Eva.

John Karem said this was done even though the nursing home had do-not-resuscitate or DNR orders on file.

“What we saw on the night of our mother’s death was a large man pounding on her chest,” said Karem.

“Was she somehow aware that this was not going the way she wanted?” he asked. “The questions keep coming. … But the pain, agony, frustration and anger just linger.”

Pat Mulloy, president of Louisville-based Senior Care Inc. which owns Jefferson Manor, declined to comment.

Karem said he has filed a complaint with Reynolds’ office in his mother’s case and met last week with Reynolds and state Rep. Bob DeWeese, R-Louisville, to try to come up with a better way to alert caregivers to a person’s wishes and prevent errors.

“We will continue to talk with provider groups, advocates, families, legislators and surveyors to ensure that whatever action is taken is well thought out and clear, because we all have the same goal of respecting residents’ wishes,” Reynolds said.

Federal and state laws require that hospitals and nursing homes keep do-not-resuscitate orders in a patient’s chart. But when it comes to how those orders are carried out at the bedside, it is up to the facility. Some use color-coded wrist bands, colored tape on residents’ doors or stickers on their charts.

In Ashland, the resident’s death led to the state issuing Woodland Oaks the most serious citation a nursing home can get.

The nursing home is appealing the citation, according to Cheryl Harrison, an attorney for Woodland Oaks.

Bernie Vonderheide, president of Kentuckians for Nursing Home Reform, who attended the meeting last week with Karem and Reynolds, said that any solution should be mandated through the General Assembly so that it will be followed uniformly.

Tim Veno, president and CEO of the Kentucky Association of Homes and Services for the Aging, a group that represents long-term care providers, was also at the meeting and is asking that a panel of professionals come up with recommendations of best practices.

The Kentucky Hospital Association recently surveyed hospitals about their methods and next month is putting together a team that will decide on voluntary uniform procedures, possibly including a colored wrist band, according to spokeswoman Elizabeth Cobb.