Failure to Provide Safe and Appropriate Respiratory Care
Penalty
Summary
The facility failed to provide safe and appropriate respiratory care for two residents who required such care, as observed and documented by surveyors. For one resident, who had diagnoses including dementia, hyperlipidemia, bradycardia, and hypertension, the physician's order specified oxygen administration at 2-3 liters per minute via nasal cannula as needed for shortness of breath. However, during observation, the resident was found receiving oxygen at 4.5 liters per minute, exceeding the prescribed range. Interviews with the DON and Administrator revealed a lack of documentation regarding any resident manipulation of the oxygen concentrator and uncertainty about when staff were last in-serviced on oxygen concentrator use. Both the DON and Administrator stated that monitoring the oxygen settings was the responsibility of the charge nurses, but neither could confirm consistent oversight or recent staff training on this process. For another resident with chronic obstructive pulmonary disease, heart failure, and hypertension, the care plan and physician's orders required oxygen therapy as needed, with specific instructions to maintain oxygen saturation above 92%. During multiple observations, the resident's nasal cannula was found improperly stored—hanging from the bed rail or placed on top of the oxygen concentrator, and not kept in a bag as required for infection control. The resident confirmed that the nasal cannula was never stored in a bag, and staff interviews corroborated that the cannula should be bagged to prevent contamination. The ADON and DON both stated that all staff were responsible for ensuring proper storage, but acknowledged that this was not consistently done. The facility's policy on oxygen administration outlined procedures for safe oxygen delivery but did not address the storage of nasal cannulas. Despite this, staff interviews indicated an expectation for nasal cannulas to be stored in bags to prevent infection. The lack of adherence to physician orders for oxygen flow rates and improper storage of respiratory equipment constituted failures to follow professional standards of practice for respiratory care.