Deficient Respiratory Care and Infection Control for Residents Requiring Oxygen and BiPAP
Penalty
Summary
The facility failed to provide safe and appropriate respiratory care and services in accordance with professional standards of practice for four residents requiring respiratory support. For one resident with acute respiratory failure, COPD, and CHF, the BiPAP mask was observed hanging on the wheelchair brake handle, not stored in a manner free from contamination. The BiPAP mask and nebulizer were stored together in an unlabelled plastic bag, lacking the resident's name and the date of last change. Staff interviews revealed inconsistent cleaning practices for the BiPAP mask, with some staff using alcohol wipes and others using soap and water, but without documentation of cleaning or adherence to the manufacturer's instructions. The care plan did not specify cleaning frequency or duration of BiPAP therapy, and administration records lacked consistent documentation of BiPAP use and cleaning, contrary to facility policy and manufacturer guidelines. For three other residents with diagnoses including acute respiratory failure, pneumonia, and COPD, oxygen was administered via nasal cannula or nebulizer, but the tubing and masks were not labeled with the date of last change. In some cases, nebulizer equipment was observed stored in a plastic bag with an outdated date, and in others, the tubing was not dated at all. Staff interviews confirmed that respiratory tubing and masks should be labeled and changed at regular intervals, as per facility policy, but this was not consistently done. The facility's policies required disposable supplies to be changed every 5 to 10 days and labeled with the date of last change, but these procedures were not followed. The Director of Nursing and other staff acknowledged that failure to clean and document respiratory equipment care, as well as improper storage and labeling, could lead to bacterial accumulation and potential infection. Facility policies and manufacturer instructions were reviewed, all of which emphasized the importance of regular cleaning, proper storage, and documentation of respiratory care. However, observations and staff interviews demonstrated that these standards were not consistently met for the residents reviewed, resulting in deficiencies in respiratory care and infection control practices.