Lack of Staff Training and Competency for Trilogy Ventilator Use
Penalty
Summary
The facility failed to provide staff training and competency testing for the use of a Trilogy machine, a noninvasive ventilator, for two residents who required this specialized respiratory support. Record reviews showed that the facility's assessment did not identify the capability or capacity to provide specialized respiratory care or services, despite having a policy in place for noninvasive ventilation. The policy outlined the use of devices such as CPAP, BiPAP, AVAPS, and Trilogy, but there was no evidence that staff were trained or tested for competency in using these machines. For one resident, the medical record indicated a history of chronic hypercapnic respiratory failure, COPD, obstructive sleep apnea, aspergillosis, histoplasmosis, and other lung conditions, with physician orders for specific Trilogy machine settings. The resident's care plan did not mention the use of the Trilogy machine, although the medication administration record showed that noninvasive ventilation was provided as ordered. Observations confirmed the presence of the Trilogy machine in the resident's room, and the DON acknowledged that staff had not received training on its use. Another resident with COPD, idiopathic sleep-related nonobstructive alveolar hypoventilation, and sleep apnea also had physician orders for Trilogy machine use. The care plan referenced CPAP/BiPAP but did not include interventions for the Trilogy machine. The resident reported needing assistance with the Trilogy mask and noted that only some nurses were knowledgeable about its use, while others were not. The DON confirmed the lack of staff training on the Trilogy machine for this resident as well.