Failure to Follow Physician Orders for Oxygen Therapy and Proper Storage of Nebulizer Equipment
Penalty
Summary
Surveyors observed that two residents were not receiving oxygen therapy in accordance with their physician orders. One resident was administered oxygen at 3 liters per minute (lpm) via nasal cannula, while the physician order specified 2 lpm continuously. This resident had a medical history including acute respiratory failure with hypoxia, chronic obstructive pulmonary disease with acute exacerbation, non-ST elevation myocardial infarction, and dependence on supplemental oxygen. Another resident was observed receiving oxygen at 4 lpm via nasal cannula, despite a physician order for 2 lpm continuously. This resident's diagnoses included dependence on supplemental oxygen and shortness of breath. In both cases, the Director of Nursing confirmed that physician orders should be followed for oxygen administration, and facility policy required checking the physician’s order and setting the correct flow rate. Additionally, a third resident’s nebulizer mask was found resting on top of the nebulizer machine and not stored in a plastic storage bag when not in use, as required by facility policy. The resident had a physician order for Ipratropium-Albuterol inhalation solution to be administered as needed for shortness of breath or wheezing, with the last administration documented the previous day. Both the unit manager and the Director of Nursing confirmed that nebulizer masks should be stored in a plastic bag when not in use, in accordance with the facility’s aerosol therapy policy.