Failure to Provide Ordered BiPAP Respiratory Care
Penalty
Summary
Facility staff failed to ensure that a resident with a diagnosis of heart failure received appropriate respiratory care as ordered. The resident required BiPAP therapy while sleeping or napping, as documented in physician orders and the treatment administration record (TAR). Multiple instances were identified where the BiPAP was not applied during various shifts across September and October, despite clear orders. The resident was cognitively intact and required extensive to total assistance with activities of daily living. Documentation showed that the BiPAP was not used on several occasions, and there was no record of resident refusal or staff documentation of such refusals. Interviews with staff revealed confusion and lack of communication regarding responsibility for applying the BiPAP mask. Medication aides indicated that only nurses could apply the mask, but nurses interviewed were either unaware of the resident's needs or had not been informed of the mask not being in use. Observations confirmed the resident was not wearing the BiPAP mask when required, and the resident reported discomfort from air blowing in the eyes when the mask was applied. The Director of Nursing confirmed that the nurse assigned to the resident should have ensured the BiPAP was applied and documented any refusals, which did not occur.