Failure to Prevent Accident Hazards Related to Vaping and Oxygen Use
Penalty
Summary
The facility failed to ensure the resident environment was free from accident hazards by allowing a resident to use a vape (e-cigarette) while receiving oxygen via nasal cannula in her room. Observation confirmed that the resident was using a vape while on four liters of oxygen, with her roommate present and exposed to secondhand vaping aerosol. The facility's policy on electronic cigarettes did not address the risks associated with oxygen use, storage of nicotine liquid, or the exposure risk of others to secondhand smoke. Additionally, educational materials provided to residents and families did not mention the dangers of vaping while using oxygen. Record review showed that the resident using the vape had diagnoses including COPD, chronic kidney disease, and type 2 diabetes mellitus, and was assessed as cognitively intact. The care plan and smoking assessment noted daily vaping and the need to monitor for safety concerns, but did not specifically address the risk of vaping while on oxygen. Interviews with staff, including a KMA and the DON, revealed a lack of awareness regarding the dangers of vaping around oxygen, with both initially believing it was safe. The roommate had not been educated on the risks of secondhand exposure from vaping.