Failure to Monitor and Administer Nebulizer Treatment as Required
Penalty
Summary
A deficiency occurred when a resident with multiple diagnoses, including COPD, dementia, and hemiplegia, did not receive safe and appropriate respiratory care during a nebulizer treatment. During observation, the resident was found lying in bed with the nebulizer running, but the mask was not on the resident and was instead lying next to him, disconnected from the medication cup. The LPN was notified and assisted the resident in putting the mask back on, but then left the room to administer medications to another resident. When the LPN returned, the resident was again not wearing the mask, which was lying next to him, and the treatment was completed at that time. The resident's medical record indicated severe cognitive impairment and a need for substantial to maximum assistance with activities of daily living. The care plan required oxygen therapy, and physician orders specified nebulizer treatments four times daily. The facility's policy, based on the Lippincott procedure and an approved addendum, required staff to remain with the patient and continue the treatment until the nebulizer began to sputter. The LPN reported that she typically set a timer and monitored the resident via video, acknowledging the resident's tendency to remove the mask due to confusion and impulsivity. The failure to remain with the resident during the treatment and ensure the mask was worn as required led to the deficiency.