Failure to Obtain and Follow Physician Orders for Oxygen Therapy
Penalty
Summary
The facility failed to provide respiratory care and services in accordance with professional standards of practice for two residents who required oxygen therapy. For one resident with diagnoses including COPD and acute respiratory failure with hypoxia, there was no physician order specifying the use or liter flow of oxygen, despite the resident being observed using oxygen and having a care plan indicating oxygen dependence. The resident was also found with the oxygen concentrator turned off while the nasal cannula remained in place, and staff were unaware of the lack of physician orders or the oxygen being turned off. For another resident with COPD, CHF, obstructive sleep apnea, and obesity hypoventilation syndrome, there were no active physician orders for the use of intermittent or PRN oxygen, even though the resident was observed using oxygen during the day and documentation indicated intermittent oxygen use over several weeks. The resident's medical record included progress notes and nursing documentation referencing oxygen use, but no corresponding physician orders for daytime or PRN oxygen administration or prescribed liter flow were present. Interviews with nursing staff and unit managers confirmed that both residents were receiving oxygen therapy without the required physician orders, and staff acknowledged that such orders should have been in place. The facility's own policy and professional guidelines require verification and review of physician orders for oxygen administration, which was not followed in these cases.