Failure to Obtain Physician Orders for Resident's Respiratory Devices
Penalty
Summary
The facility failed to obtain physician's orders or conduct an assessment for the use of a cough assist device and an airway clearance device (suctioning) for a resident diagnosed with amyotrophic lateral sclerosis (ALS), dysphagia, rheumatoid arthritis, depression, and anxiety. The resident, who was admitted from home and receiving hospice services, was cognitively intact but unable to speak, requiring substantial to maximal assistance with daily activities and dependent on staff for transfers and mobility. The resident communicated using a whiteboard and had a gastric tube for nutrition, with orders entered for her supplements. Despite the resident's use of a ventilator at night and the presence of an airway clearance device at bedside, there were no physician's orders for the cough assist or suctioning devices. Interviews with the DON and Corporate Nurse Consultant confirmed that the resident had brought the respiratory equipment from home and used them as needed, but the facility had not entered corresponding care plan entries or physician orders for these devices. The hospice care plan indicated hospice was responsible for medical supplies, but the facility lacked documentation and policy regarding the use of these respiratory devices.