Failure to Obtain Physician Orders and Maintain Respiratory Equipment Hygiene
Penalty
Summary
The facility failed to obtain physician orders for oxygen use and did not provide proper hygienic care and storage of nebulizer equipment for two residents requiring respiratory care. One resident was observed in bed using oxygen at 3 liters per minute, with their nebulizer mask and tubing left uncovered in an open drawer. The resident reported receiving daily nebulizer treatments, and the medication administration record confirmed four daily Ipratropium-Albuterol nebulizer treatments. However, there was no documented order or schedule for changing the nebulizer tubing. A registered nurse confirmed that the tubing and mask should be changed weekly, cleaned nightly, and stored in a bag, but the equipment was found uncovered and improperly stored. Another resident was observed using oxygen at 2 liters per minute via nasal cannula, stating that oxygen use began after a recent hospital admission. There were no active physician orders for oxygen use in the medical record, and nursing notes documented ongoing oxygen use since admission. The assistant director of nursing acknowledged that physician orders for oxygen and flow rate were required and confirmed that the hospital discharge orders did not include oxygen. The facility's policy required weekly changes and daily cleaning and proper storage of nebulizer equipment, which was not followed in these cases.