Failure to Obtain and Document Physician Orders for Bipap Settings
Penalty
Summary
The facility failed to ensure that a resident requiring respiratory care, specifically the use of a Bipap machine for obstructive sleep apnea, received care consistent with professional standards and the resident's care plan. Upon admission, the resident brought his own Bipap machine and used it nightly, as indicated in his care plan and physician's order. However, the physician's order did not specify the required Bipap settings, and this omission persisted from admission through the time of the survey. The resident was cognitively intact, able to communicate his needs, and independently used the Bipap machine at night, but was unaware of the correct settings. Interviews with facility staff, including the charge nurse and DON, revealed that neither the Bipap settings nor the process for verifying them were documented or known. The charge nurse was unable to locate the settings in the electronic medical record, and the DON acknowledged that a physician's order specifying the settings was necessary but had not been obtained. The facility's policy required Bipap setup by a respiratory therapist with a physician's order, but this was not followed. This deficiency was identified through observation, interviews, and record review, and involved a resident with multiple diagnoses including obstructive sleep apnea and mitral valve insufficiency.