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F0760
D

Failure to Administer Physician-Ordered Nebulizer Treatments

Rock Island, Illinois Survey Completed on 09-24-2025

Penalty

No penalty information released
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The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

A resident with a history of acute respiratory failure with hypoxia, pneumonia, COPD with acute exacerbation, chronic systolic heart failure, atrial fibrillation, and hypertension was admitted to the facility with hospital discharge orders for Albuterol nebulizer treatments every six hours. The facility's Medication Administration Policy requires accurate administration of all medications as ordered. Review of the resident's medical record, order summary, and medication administration records showed no documentation that the prescribed nebulizer treatments were administered. The resident reported not receiving any nebulizer treatments during their stay and stated that they requested discharge due to not receiving necessary medication. The facility nurse practitioner confirmed that the nebulizer treatment orders were neither transcribed nor administered as ordered.

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