Failure to Provide Physician-Ordered Oxygen Therapy
Penalty
Summary
The facility failed to provide safe and appropriate respiratory care for two residents who required oxygen therapy. For one resident with a history of COPD, dependence on supplemental oxygen, and other significant medical conditions, there was no current physician order for oxygen therapy despite the resident receiving continuous oxygen via nasal cannula. The care plan indicated a need for oxygen at 4L/min, and records showed ongoing use of oxygen since readmission, but the last documented physician order for oxygen had been discontinued months prior. The Director of Nursing confirmed that an order should have been in place and was not. For another resident with COPD exacerbation and congestive heart failure, the physician's order specified oxygen at 2 LPM via nasal cannula continuously. However, observations revealed that the oxygen concentrator was set at 3.5 LPM, exceeding the ordered flow rate. Multiple staff interviews confirmed that nurses were responsible for setting the oxygen flow rate according to physician orders, but the actual setting did not match the order. There was also confusion among staff regarding standing orders and titration parameters, but documentation and orders reviewed did not support the higher flow rate being used at the time of observation. The facility's own oxygen therapy policy required verification of physician orders for oxygen administration, including method of delivery and flow rate, and documentation of the resident's response. In both cases, the facility did not ensure that oxygen therapy was provided in accordance with physician orders and professional standards of practice, as required by the residents' care plans and the facility's policy.