Failure to Provide Safe and Appropriate Respiratory Care
Penalty
Summary
The facility failed to provide appropriate respiratory care for three residents as evidenced by multiple observations and staff confirmations. One resident with diagnoses including high blood pressure and muscle weakness was observed receiving oxygen at a rate higher than ordered by the physician, and the humidification bottle attached to the oxygen setup was empty. A registered nurse confirmed that the resident was not receiving oxygen at the prescribed rate and that the humidification bottle was not filled as required. Another resident with chronic obstructive pulmonary disease, anemia, and obstructive sleep apnea had a physician's order and care plan for BiPAP use at night. However, the BiPAP mask was repeatedly observed left on the bed and not stored in a bag as required by facility policy, with two different LPNs confirming this failure. A third resident, diagnosed with Alzheimer's disease, difficulty swallowing, and muscle weakness, was observed receiving oxygen via nasal cannula that was not dated as required. A registered nurse confirmed the lack of dating on the nasal cannula. The Director of Nursing acknowledged that the facility failed to provide appropriate respiratory care for these three residents.