Failure to Address and Care Plan Resident's Repeated Oxygen Therapy Refusals
Penalty
Summary
The facility failed to analyze and care plan a resident's repeated declinations to wear supplemental oxygen as ordered. The resident, who had diagnoses including COPD, respiratory failure, heart failure, and other chronic conditions, was ordered to receive continuous supplemental oxygen to maintain oxygen saturation at or above 90%. Despite this, documentation and observations revealed that the resident frequently did not wear the prescribed oxygen, with multiple instances of refusal or removal of the nasal cannula noted in progress notes and during direct observation. The care plan for the resident included interventions such as assisting with oxygen tank changes, setting the oxygen flow rate, and monitoring oxygen saturation, but it did not address the resident's refusals or any alternative strategies for non-compliance. Staff documented several occasions where the resident either refused or removed the oxygen, sometimes after education on risks and benefits, but there was no evidence that these refusals were analyzed or incorporated into the care plan. Provider notes also lacked documentation of these refusals, and there was no indication that the care plan was updated to reflect the ongoing issue. Interviews with staff confirmed that the resident often removed the nasal cannula, sometimes unintentionally, and that staff would encourage use and notify the provider. However, there was inconsistency in staff awareness and documentation of the refusals, and the assistant director of nursing stated that ongoing issues should be care planned. The facility's policy required explanations for medications or treatments not administered, but this was not consistently followed for the resident's oxygen therapy refusals.