Failure to Individualize Care Plan for Oxygen Use and Smoking Preferences
Penalty
Summary
The facility failed to develop an individualized care plan addressing a resident's needs and preferences regarding oxygen administration, particularly in relation to the resident's smoking habits. The resident, who had diagnoses including COPD, tachycardia, and a mood disorder, was assessed as cognitively intact and had a physician's order for continuous oxygen at 3 LPM via nasal cannula. However, observations revealed the resident was using oxygen at 5 LPM, adjusted the flow rate independently, and routinely removed the oxygen to go outside and smoke. The care plan only addressed smoking supervision and notification of the facility's smoking policy, with no interventions or documentation regarding the resident's oxygen use preferences or behaviors related to non-compliance with the physician's order. Interviews with staff, including an LPN and the DON, confirmed awareness of the resident's self-adjustment of oxygen and non-compliance with the prescribed order, but there was no documentation of these behaviors in the medical record. The DON acknowledged that the care plan was not personalized to reflect the resident's specific needs and preferences regarding oxygen use and smoking. The facility's policy required comprehensive and regularly updated care plans based on resident assessments, but this was not followed in this case.