Failure to Administer Oxygen as Ordered and Without Physician Order
Penalty
Summary
The facility failed to provide safe and appropriate respiratory care for two residents who required oxygen therapy. For one resident with diagnoses including COPD, chronic respiratory failure with hypoxia, and heart failure, the physician's order specified oxygen at 2 liters per minute (LPM) via nasal cannula continuously. However, observations on multiple occasions revealed that the oxygen concentrator was set below the ordered rate, at 1.5 LPM and under 2 LPM. The LPN confirmed the setting was incorrect and adjusted it only after being prompted during the survey. For another resident with chronic respiratory failure, COPD, and heart disease, there were no physician orders for oxygen therapy in the electronic medical record prior to the survey, despite the resident being observed wearing oxygen at 2 LPM via nasal cannula on two separate occasions. The LPN was unable to locate any oxygen orders after searching the record and could not explain the basis for administering oxygen. The care plan for this resident did not address respiratory conditions until the deficiency was identified during the survey, at which point a problem of COPD was added and an order for oxygen was obtained. Facility policy required that oxygen be administered only with a physician's order and at the prescribed flow rate, and both the Administrator and DON confirmed that staff are expected to follow these orders. The failure to administer oxygen at the correct setting for one resident and to ensure a physician's order was in place for another constituted a deficiency in respiratory care, as staff did not adhere to established protocols and physician instructions.