Failure to Obtain Timely Physician Order for BiPAP Use
Penalty
Summary
A deficiency was identified when a resident with a history of acute and chronic respiratory failure, chronic obstructive pulmonary disease (COPD), and other respiratory conditions was found to be using a BiPAP machine without a physician's order for an extended period. The resident had been admitted with the BiPAP device, and documentation showed use of the machine since November of the previous year. However, a review of the medical record revealed that a physician's order for the BiPAP was not obtained until several months later, despite the resident's ongoing use of the equipment. Interviews with nursing staff and facility leadership confirmed that the expectation was for all respiratory interventions, such as BiPAP, to have a corresponding physician's order. The care plan for the resident included the use of BiPAP as ordered, but the lack of a timely order was not identified or addressed until it was brought to the attention of the Director of Nursing and the Licensed Nursing Home Administrator during the survey. Facility policy required verification of complete and accurate physician orders for all interventions, which was not followed in this instance.