Failure to Change Oxygen Tubing Per Physician Order
Penalty
Summary
The facility failed to ensure that a resident's oxygen tubing was changed according to the physician's order and standard practice. Observations on two separate dates showed the resident wearing oxygen tubing labeled with a date from over a month prior, despite a physician order specifying that the tubing and humidifier bottles should be changed weekly on Sundays during the night shift. The resident, who had diagnoses including chronic obstructive pulmonary disease and chronic respiratory failure, was unable to recall when the tubing was last changed and acknowledged it was likely due for replacement. Both an LPN and the Director of Nursing confirmed that the tubing was not dated appropriately and should have been changed weekly as per the order and facility protocol.