Health & Medicine

System suggested for DNR tracking

A Louisville nursing home has been cited by state inspectors after the staff tried to resuscitate a 95-year-old resident despite a "do not resuscitate" order for the woman.

Because Kentucky has no uniform regulations for carrying out resuscitation decisions at the bedside, two Kentucky groups that set standards for hospitals and nursing homes are considering whether the state should join other states in using a purple armband for patients who have a DNR order.

"To have hospitals, rehab centers and nursing homes to use the same color code makes perfect sense," said John Karem, whose mother, Eva, died in February 2008 after staff at Jefferson Manor Nursing Home in Louisville tried to revive her even though she had a DNR order. The nursing home received a citation on March 27 for ignoring the DNR order.

Using the standard bands would "eliminate the multiple incidents of DNR errors," Karem said.

Color-coded wristbands are used to quickly communicate health conditions or a patient's status. In several states, hospitals and nursing homes are voluntarily using a standardized purple armband to show that a patient does not want to be resuscitated, a yellow armband for patients who are at risk of falling, and a red armband for those with allergies.

The Kentucky Hospital Association will take up a proposal in June calling for hospitals to voluntarily begin using those standardized colors. Any KHA decision on the armbands would result only in a recommendation to the hospitals, not a mandate.

Meanwhile, Sadiqa Reynolds, the inspector general of the Cabinet for Health and Family Services, is meeting with long-term care industry officials, advocates, family members such as Karem and state Rep. Bob DeWeese, R-Louisville, to discuss the use of armbands in nursing homes.

Reynolds is working with lawmakers and long-term care providers to come up with a proposal to create a consistent way to identify DNR residents without compromising those patients' right to privacy, said Cabinet spokeswoman Beth Fisher. The group is reviewing concerns that the armbands would compromise patients' confidentiality, Fisher said.

Karem said he is pushing for the purple armbands, calling it a "mission."

When Eva Karem's respiration and pulse stopped on Feb. 20, 2008, Jefferson Manor initiated CPR even though a document dated Feb. 12 said that treatment should be withheld, according to documents the Herald-Leader received under the Kentucky Open Records Act.

According to the documents, Jefferson Manor's administrator, who was not named, acknowledged to state inspectors that the facility failed to address Karem's DNR status when she was admitted and failed to follow up to ensure that her DNR status was accurate.

Pat Mulloy, president of Louisville-based Senior Care Inc. which owns Jefferson Manor, declined to comment. Federal and state laws require that hospitals and nursing homes keep DNR orders in a patient's chart.

But in carrying out those orders at the bedside, facilities use different methods. Some use color-coded wristbands, colored tape on residents' doors or stickers on their charts. KHA spokeswoman Elizabeth Cobb said a KHA work group surveyed Kentucky hospitals about their procedures before deciding to ask the board to implement the purple, red and yellow standardized system of wristbands.

If the KHA board approves the use of the armbands, it will provide resources and support to hospitals that implement the policy, Cobb said.

Arizona was the first state in the nation to adopt a voluntary statewide, color-coded wristband policy in 2007. The system — the same one under consideration in Kentucky — has been "widely embraced by hospitals in Arizona," said Bridget O'Gara, vice president of the Arizona Hospital and Healthcare Association. A survey showed that nearly every hospital in the state was participating,

"We believe it's an important patient safety program," said O'Gara.

Hospital patients in Arizona wearing colored social cause wristbands — such as the Lance Armstrong "Live Strong" band — are asked to remove them upon being admitted.

Cobb said she knew of no DNR errors that have occurred in Kentucky hospitals.

In another nursing home case, an Ashland nursing home was cited in January for allegedly failing to perform CPR on a dying patient who had requested life-saving measures.

Cheryl Harrison, a lawyer for Woodland Oaks Healthcare Center, said the facility denies the allegation and is appealing the citation.

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