RCS Voices Concerns Regarding Facility Failed Practices Related to CPR

In recent discussions with Residential Care Services leadership, concerns were raised related to recent deficiencies regarding facility staff response in emergencies, specifically related to the initiation of CPR (Cardiopulmonary Resuscitation). It is important to note that Appendix PP of the State Operations Manual includes requirements regarding CPR in nursing homes, which are primarily related to emergency care and staff competency.

Key elements of the CPR-Related Requirements in CMS Appendix PP include the following:

1. Initiation of CPR in an Emergency

• Facilities must provide basic life support, including CPR, to a resident in cardiac arrest, in accordance with the resident’s advance directives or in the absence of a DNR (Do Not Resuscitate) order.
• Staff are expected to initiate CPR immediately unless:
  • There is a valid DNR order
  • The resident is obviously deceased (e.g., rigor mortis, decapitation, decomposition)

2. Staff Competency and Training

• Nursing homes must ensure that CPR-certified staff are available at all times.
• Staff expected to perform CPR must maintain current certification from a recognized organization (e.g., American Heart Association, American Red Cross).
• Facilities cannot rely solely on emergency medical services (EMS); they must provide immediate CPR until EMS arrives.

3. Policies and Procedures

• Nursing homes must have written policies that align with federal regulations and residents’ rights, including:
  • Clearly defining the facility’s CPR procedures,
  • Ensuring residents’ advance directives and/or POLST are readily accessible and honored,
  • Ensuring timely initiation of CPR if appropriate.

If you have questions, please reach out to your RCS Field Manager, or contact Elena Madrid.