Failure to Follow Physician Orders and Notify Provider for CPAP Refusals
Penalty
Summary
The facility failed to follow physician orders and ensure provider notification regarding a resident's refusals for continuous positive airway pressure (CPAP) therapy. The resident, who had diagnoses including pulmonary fibrosis, acute and chronic respiratory failure, COPD, and obstructive sleep apnea, had physician orders for nightly CPAP use with documentation of hours worn and refusals. Despite these orders, staff documented CPAP use and refusals in the medication and treatment administration records, but on multiple occasions, the CPAP was not present in the resident's room after a room transfer, and the resident was not offered the device as required. Staff also failed to notify the provider of the resident's consistent refusals to use the CPAP, as confirmed by interviews with nursing staff and the nurse practitioner, who was unaware of the refusals. Additionally, the resident's care plan identified behaviors such as agitation and refusal of care, with instructions for staff to encourage CPAP use and notify the charge nurse of refusals. However, during the resident's transfer to a new room, the CPAP was not moved, and staff did not ensure its availability or offer it to the resident. Documentation in the records indicated completion of CPAP care even when the device was not present. The facility was unable to provide a policy regarding refusal of physician orders and provider notification when requested.