Failure to Provide Physician-Ordered Respiratory Services
Penalty
Summary
The facility failed to provide respiratory services as ordered by the physician for a resident with multiple diagnoses, including Parkinson's disease and chronic obstructive pulmonary disease. The resident had active physician orders for oxygen therapy, specifying use of oxygen via nasal cannula at 2-4 Lpm if oxygen saturation was less than 90%, and 2 Lpm at bedtime. During observation, the resident was found sitting in a wheelchair without the oxygen cannula in place, while the oxygen concentrator was running and the tubing was stored in a plastic bag. The resident appeared lethargic and was not responding to most questions or prompts from the CNA assisting with activities of daily living. The CNA stated she would reapply the oxygen after completing morning care. An LPN later confirmed the resident had required oxygen during the day over the weekend due to shortness of breath and low oxygen saturation, and acknowledged the resident was acting confused and lethargic, which can indicate low oxygen levels. Upon assessment, the resident's oxygen saturation was found to be 81% on room air, prompting the LPN to apply oxygen at 2 Lpm and increase it to 4 Lpm to achieve a saturation above 90%. The LPN instructed the CNA to notify licensed nursing staff if residents exhibit lethargy or unresponsiveness. The DON confirmed that residents showing such symptoms should be assessed for low oxygen saturation, which had not occurred in this instance.