Qualilty Improvement for Senior Living Communities
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Cardiopulmonary Resuscitation (CPR) in Nursing Homes

Officials at the Centers for Medicare & Medicaid Services (CMS) announced in new rules recently that prior to the arrival of EMS, nursing homes must provide basic life support, including initiation of CPR, to a resident who experiences cardiac arrest in accordance with that resident's advance directives or in the absence of advance directives or a DNR order.

This means that CPR-certified staff must be available at all times to provide CPR when needed. Facilities must not establish and implement facility-wide "No CPR" policies for their residents; nor should they limit staff to only calling 911 when a cardiac arrest occurs. CMS further reminded providers that every resident has a right to formulate an advance directive under F155, and staff must inform them of that right and abide by their directives.

The following are steps to help ensure your facility is in compliance with both regulatory and resident CPR directives:

  • Always ensure that crash carts (or similar storage units) are organized and equipped with all the resources needed to handle an emergency situation in your facility. Develop a checklist, perform audits, and test equipment routinely. Keep logs of these activities. Store the cart in a safe, but easily accessible, place. Store CPR masks/shields in accessible places as well, possibly in or near residents' rooms.

  • Provide an annual review and in-service staff meeting on the proper use of emergency equipment. Stage mock-emergency drills periodically.

  • Administrative personnel should familiarize themselves with their state's laws on advance directives, resuscitation decisions, and the determination of death. Some questions to explore are:

    • Can a nurse pronounce a resident's death and, if so, under what circumstances?

    • Can an advance directive to withhold resuscitation be honored if there is no physician order?

  • Develop nursing policies and procedures that outline which levels of staff members will initiate CPR (e.g. nurses, CNAs, etc.). Make sure the appropriate staff members are trained in CPR by a certified agency/trainer. Keep a record of the certification/expiration dates.

  • Develop an advance directive and DNR policy and procedure; educate staff accordingly. Train personnel to educate residents and family members about end-of-life treatment options. Give incoming residents a statement of rights with regard to making health care decisions based on the law of the state in which the facility is located.

  • Have a system in place to ascertain resident wishes regarding resuscitation and DNR status before an emergency arises. Ensure physician orders (that reflect the resident's wishes) are obtained in a timely manner. If the resident can no longer communicate and there is no surrogate decision-maker, try to determine what types of treatments the resident would want by talking to relatives and friends, then document these findings.

  • Ensure that caregivers know which residents have DNR orders and which do not. Keep a copy of the resident's advance directives and related physician orders in the resident's chart and be sure to flag resident charts and Kardexs accordingly.

By heeding these precautionary measures, you can decrease confusion over treatment decisions and better ensure that the wishes of the residents in your facility are fulfilled.

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