Failure to Properly Store CPAP/BIPAP Masks for Multiple Residents
Penalty
Summary
The facility failed to provide appropriate respiratory care for three residents who required CPAP/BIPAP therapy. According to facility policy, CPAP/BIPAP masks are to be bagged when not in use, and staff are to document how residents tolerate the procedure. For all three residents, observations on two consecutive days revealed that their CPAP masks were left lying unbagged on their bedside tables, contrary to policy requirements. These findings were confirmed by a registered nurse during interviews. The residents involved had significant medical histories, including chronic obstructive pulmonary disease, diabetes, high blood pressure, stroke, hemiplegia, and anemia, and all had physician orders and care plans specifying the use and maintenance of CPAP/BIPAP equipment. Despite clear physician orders and care plan instructions regarding the application, cleaning, and storage of CPAP/BIPAP equipment, staff did not ensure that the masks were properly bagged when not in use. The Director of Nursing confirmed the failure to provide appropriate respiratory care for these residents. The deficiency was cited under state regulations concerning the responsibility of the licensee, resident care policies, and nursing services.