Oxygen Therapy Administered Without Physician Order
Penalty
Summary
A deficiency was identified when a resident with multiple diagnoses, including cirrhosis of the liver, ascites, type 2 diabetes mellitus, and depression, received oxygen therapy without a physician's order. Clinical record review showed that although the resident had orders to monitor temperature and oxygen saturation, there was no documented physician order for oxygen therapy from admission until several months later. Nursing notes indicated the resident was on continuous oxygen at 2 liters, with documented episodes of low oxygen saturation and subsequent increases in oxygen flow, but these interventions were not supported by a physician's order in the medical record. The care plan also did not reflect oxygen therapy during this period. Interviews with nursing staff revealed that it was common practice to initiate oxygen therapy or adjust oxygen flow in response to low oxygen saturation, and then notify the charge nurse and physician to obtain an order. However, in this case, the facility was unable to provide evidence of a standing or timely physician order for oxygen therapy during the period in question. Facility policy required that oxygen therapy be administered as ordered by a physician or as an emergency measure until an order could be obtained, but documentation did not show that an order was obtained in a timely manner.