Failure to Obtain Physician Order and Monitor Bi-pap Use
Penalty
Summary
The facility failed to obtain a current physician order and provide appropriate monitoring for a resident using a Bi-pap non-invasive ventilation device. The resident, who had multiple complex diagnoses including acute respiratory failure with hypoxia, obstructive sleep apnea, and other chronic conditions, was observed on two occasions using the Bi-pap machine with oxygen. However, review of the medical record showed that the only physician order for Bi-pap had been discontinued, and there was no active order specifying the settings, application, or monitoring requirements for the device. Additionally, the resident's care plan did not address the use of oxygen or Bi-pap, and the comprehensive MDS assessment did not indicate the use of these respiratory therapies. Further review of the resident's records revealed ongoing orders for oxygen therapy but none for Bi-pap after the previous order was discontinued. Interdisciplinary team notes indicated the resident was non-compliant with Bi-pap but would use nasal cannula oxygen. Despite this, direct observation confirmed the resident was using the Bi-pap device without a current physician order or documented monitoring. Interview with the regional nurse confirmed the absence of an order for the Bi-pap machine's use and monitoring.