Failure to Provide Appropriate Respiratory Care and Documentation
Penalty
Summary
The facility failed to provide appropriate respiratory care for two residents who required the use of BiPAP and CPAP machines. One resident, who had diagnoses including quadriplegia and sleep apnea, reported not using his BiPAP machine for approximately two months due to incorrect settings and lack of physician adjustment. He stated that he had only seen a respiratory therapist once during his stay, and the settings were not corrected at that time. The resident also indicated that staff asked him for the correct settings, which caused frustration as he expected the facility to have this information. The care plan for this resident did not include specific interventions or settings for the BiPAP machine, and there was no documentation of a follow-up pulmonology appointment as recommended by the physician. Another resident, with chronic respiratory failure and sleep apnea, reported independently managing his CPAP machine and receiving minimal assistance from staff. The care plan referenced the use of CPAP and oxygen, but there were no detailed physician's orders for the CPAP machine in the electronic medical record until the time of the survey. This lack of documented orders meant that staff did not have clear guidance on the application and management of the resident's CPAP therapy prior to the survey. Staff interviews revealed that certified nurse aides had not received training on the care of CPAP or BiPAP machines and were unfamiliar with facility policies regarding these devices. The infection preventionist confirmed that staff education on respiratory devices had not yet been provided and emphasized the need for physician's orders with specific settings in the electronic medical record. The director of nursing acknowledged that nurses were responsible for following up on missed pulmonology appointments and ensuring that physician's orders for respiratory devices were in place, but these actions had not occurred prior to the survey.