Failure to Ensure Physician Orders and Documentation for Respiratory Care
Penalty
Summary
The facility failed to provide safe and appropriate respiratory care for two residents by not ensuring proper physician orders and documentation for respiratory devices and oxygen therapy. For one resident with chronic obstructive pulmonary disease and other significant health conditions, there was a physician order for continuous oxygen at two liters via nasal cannula as needed, with instructions for nursing staff to check placement and record oxygen concentration every shift. However, the resident's Medication Administration Record (MAR) did not document oxygen use, despite multiple progress notes and observations indicating the resident was receiving oxygen at three liters per minute and wearing oxygen continuously. The program director confirmed the resident wore oxygen most of the time, but this was not reflected in the MAR, and the order was technically as needed, though the resident received it continuously. For another resident with a history of orthopedic aftercare, obstructive sleep apnea, and other comorbidities, there were no physician orders or care plan addressing the use of a CPAP machine. Observations revealed the CPAP mask was stored inappropriately on the floor under the bed without a protective bag. Interviews with the DON and regional nurse confirmed the lack of orders and improper storage. The facility's policy required a physician's order for CPAP/BiPAP devices, including machine settings, and monitoring of the resident's tolerance, but these standards were not met.