LVNs Performed Respiratory Care Outside Scope After Regulatory Change
Penalty
Summary
The facility failed to ensure that Licensed Vocational Nurses (LVNs) performed their duties within their legal scope of practice when providing care to patients, specifically those with tracheostomies. Despite regulatory changes from the Board of Vocational Nursing and Psychiatric Technicians (BVNPT) effective 10/1/25, which restricted LVNs from performing certain respiratory care tasks, LVNs continued to conduct activities such as pre- and post-nebulizer treatment assessments, tracheostomy care, suctioning, and manipulation of ventilators. These actions were documented in patient records and confirmed through staff interviews, indicating that LVNs were performing tasks outside their authorized scope. The facility's policies and procedures (P&Ps) related to respiratory care and tracheostomy management had not been updated to reflect the new BVNPT regulations. Multiple P&Ps, including those for tracheostomy tube suctioning, speaking valve cleaning, and tracheostomy care, did not specify the limitations imposed on LVNs. Staff interviews revealed that LVNs were aware of the regulatory changes but continued to perform restricted tasks due to insufficient respiratory therapist (RT) staffing. Some LVNs stated they performed these tasks out of necessity when RTs were unavailable, and documentation showed that these practices persisted after the effective date of the new regulations. Interviews with the Director of Nursing (DON), RT Manager, and other staff confirmed that the facility was aware of the changes in LVN scope of practice but had not yet fully implemented the necessary staffing adjustments or policy updates. The DON acknowledged that LVNs were performing respiratory care outside their scope and that the facility's job descriptions and policies were outdated. The RT Manager also noted that the number of RTs was insufficient to meet patient needs, leading to continued reliance on LVNs for restricted respiratory care tasks.
Plan Of Correction
Chapman Global Medical Center Plan of Correction Scope changes of LVN staff, including what respiratory care they can provide and instructing them to notify the charge nurse of any respiratory care needed that falls within the limitations defined by the BVNPT so that an RN can complete these duties. Resident #1 was assessed by the RN to ensure no adverse effects were present from the LVN providing the care to the patient. No issues were identified. By 11/15/25, all LVNs will be educated on the changes to the LVN scope of practice for providing respiratory care from the BVNPT effective 10/1/25 by their supervisor. The education will be done during unit huddles, staff meetings, or online. The DON reviewed the LVN JD and found it outdated. By 11/15/25, the Facility will revise the Job Description, Scope of Practice Policies, and Procedures in accordance with the California Vocational Nursing Practice Act and The Respiratory Care Board Regulations. All LVNs will be educated on the revised JD and will sign the new JD to ensure understanding of the changes.