Failure to Provide Safe and Appropriate Respiratory Care per Physician Orders
Penalty
Summary
The facility failed to provide respiratory care and services in accordance with physician's orders and accepted professional standards for three residents requiring respiratory support. For one resident with obstructive sleep apnea, the CPAP machine was observed with an empty humidifier reservoir on two occasions, and the physician's orders lacked essential details such as the prescribed pressure setting, instructions for checking and refilling the humidifier with distilled water, and cleaning protocols for the humidifier reservoir. The Director of Nursing confirmed these omissions and acknowledged the orders were incomplete. Another resident with obstructive sleep apnea had a CPAP and nebulizer at the bedside, but the nebulizer tubing and mask were not labeled or dated as required. The medication administration record showed blanks for the order to change and label the nebulizer equipment weekly, indicating the task was not completed or documented. Additionally, the CPAP settings for this resident were not documented in the electronic health record, and staff reported they would need to contact the pulmonologist to obtain the settings if needed. A third resident with chronic obstructive pulmonary disease and respiratory failure had an order for continuous oxygen at 2 liters via nasal cannula. Observations revealed the resident was at times without the nasal cannula, connected to an empty portable oxygen tank, or receiving oxygen at a rate different from the order. Staff confirmed these deviations from the physician's order and acknowledged that the resident did not do well without oxygen. The Director of Nursing stated that staff were expected to ensure the resident received oxygen as ordered and to update orders if changes were needed.