We had a resident admit over the weekend. He is his own responsible party. His admission packet had only been partially completed. He did not have an advanced directive or physician’s order indicating code status order. While completing the nursing admission assessment, he indicated that he did not want to be resuscitated in the event of cardiac/respiratory arrest. Would staff still be required to perform CPR since there is no signed Advance Directive and Physician’s Order?



The federal regulation regarding providing CPR is F678. – §483.24(a)(3). Personnel provide basic life support, including CPR, to a resident requiring such emergency care prior to the arrival of emergency medical personnel and subject to related physician orders and the resident’s advance directives.

Guidance for this regulation addresses what to do in the event of absence of Advanced Directive and/or Code Status order:

      • Facility staff should verify the presence of advance directives or the resident’s wishes with regard to CPR, upon admission. This may be done while doing the admission assessment.
      • If the resident’s wishes are different than the admission orders, or if the admission orders do not address the resident’s code status and the resident does not want to receive CPR, facility staff should immediately document the resident’s wishes in the medical record and contact the physician to obtain the order.
      • While awaiting the physician’s order to withhold CPR, facility staff should immediately document discussions with the resident or resident representative, including, as appropriate, a resident’s wish to refuse CPR. At a minimum, a verbal declination of CPR by a resident, or if applicable a resident’s representative, should be witnessed by two staff members, though individual States may have more specific requirements related to documenting verbal directives.
      • While the physician’s order is pending, staff should honor the documented verbal wishes of the resident or the resident’s representative, regarding CPR.


Facility policy regarding Advanced Directives and Code Status Orders should include state specific guidelines to ensure compliance with Federal and State regulations and laws.

Angie Hamer, RN, RAC-CT
Clinical Consultant

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