Failure to Ensure Safe and Appropriate Respiratory Care and Documentation
Penalty
Summary
The facility failed to provide safe and appropriate respiratory care for a resident with complex respiratory needs, specifically by not ensuring the use of a non-invasive ventilator (NIV) in accordance with physician orders and by not having a physician order for continuous oxygen administration. The resident had diagnoses including morbid obesity, chronic pain, reduced mobility, and obstructive sleep apnea, and required total assistance for mobility and personal care. The care plan did not address the resident's risk or potential for respiratory impairment, and there was no documented plan of care for respiratory treatments such as oxygen use, NIV, or inhaler use. Observations revealed that the resident was using a nasal cannula for oxygen, but the tubing was not connected to the concentrator, resulting in an oxygen saturation of 87%. Staff connected the tubing only after this was pointed out. The resident reported not using the NIV for several nights due to a lack of fluid for the machine, and staff confirmed that the necessary supplies were not available. Documentation of NIV use was incomplete, and there was no documentation of oxygen use in the medical record. The physician assistant was unaware of the resident's refusal to use the NIV and the lack of supplies, and there was no physician order for oxygen despite its ongoing use. Interviews with staff indicated a lack of communication with the provider regarding the resident's refusal or inability to use the NIV and the absence of necessary supplies. The DON confirmed that oxygen could be started per standing orders but required a provider order within 72 hours, which was not obtained. Facility policies required verification of physician orders and documentation for both oxygen administration and mechanical ventilation, but these procedures were not followed, resulting in the identified deficiencies.