Failure to Follow Physician Orders for Oxygen Therapy
Penalty
Summary
The facility failed to follow physician orders regarding oxygen therapy for two residents with respiratory disorders. For one resident with COPD and chronic respiratory failure, surveyors observed the resident using a nasal cannula incorrectly by placing it in his mouth instead of his nose, and noted discrepancies in oxygen flow rates between the concentrator and portable tank. The resident reported infrequent changes of oxygen tubing and delays in replacing portable oxygen tanks. The oxygen concentrator and tank were set at different flow rates than ordered, and the resident's Medication Administration Record (MAR) did not accurately reflect the physician's order or document the amount of oxygen administered to maintain the required oxygen saturation. Additionally, the nebulizer mask was left exposed and the machine was placed on the floor, contrary to infection control practices. The Director of Nursing confirmed that the MAR and Treatment Administration Record (TAR) did not accurately reflect the physician's orders, and that tubing changes were not documented as required. For another resident with chronic respiratory failure and emphysema, surveyors found the resident receiving oxygen at a lower flow rate than ordered and using tubing that had not been changed according to the prescribed schedule. The MAR indicated the correct order, but there was no documentation of oxygen administration on the day of the survey. The resident's nebulizer masks were also left exposed, and staff acknowledged that the physician's orders for oxygen flow rate and tubing changes were not being followed. Facility policies require that physician orders be followed as written and that oxygen therapy be administered and documented according to those orders, but these procedures were not adhered to for the residents reviewed.