Failure to Provide Safe and Appropriate Respiratory Care During Oxygen Therapy
Penalty
Summary
The facility failed to provide safe and appropriate respiratory care for two residents who were receiving oxygen therapy, in accordance with its own policies and professional standards. For one resident with pneumonia and dysphagia, observations revealed that the nasal cannula tubing was touching the floor while the resident was receiving oxygen via concentrator. Both a licensed vocational nurse and the Director of Nursing confirmed that the tubing should not touch the floor due to the risk of contamination, and facility policy required replacement of tubing if it became soiled or contaminated. For another resident with muscle wasting, atrophy, and impaired cognition, the nasal cannula tubing was observed resting on top of a suction bottle with visible white secretions, rather than being stored in a plastic bag when not in use as required by facility policy. The Infection Prevention Nurse and the DON both acknowledged that this practice did not comply with infection control protocols and could lead to cross-contamination. Record reviews confirmed that both residents had active physician orders for continuous oxygen therapy, and staff interviews indicated awareness of the need for continuous administration and proper handling of oxygen equipment. However, the observed practices did not align with the facility's written procedures for infection prevention and oxygen administration, resulting in a deficiency related to respiratory care and resident safety.