Failure to Replace and Clean Nebulizer Equipment as Required
Penalty
Summary
A deficiency was identified when a resident with severe cognitive impairment and a history of hypertension, cerebrovascular accident, aphasia, and dysphagia was found to have a nebulizer mask and tubing at the bedside that had not been changed since it was dated several months prior. The nebulizer mask was visibly dirty, with dust particles and dried liquid spots present. Observations confirmed that the equipment remained at the bedside over multiple days, and the mask/chamber was still marked with the old date. Record review showed that the resident had not received nebulizer treatments for several months, with the last documented use occurring in January, and the order for nebulizer treatments had been discontinued in February. Despite this, the equipment was not removed or cleaned according to facility policy, which required weekly replacement and nightly cleaning of the nebulizer apparatus. Staff acknowledged the outdated and unclean equipment during the survey and confirmed that the expected practice was not followed.