Failure to Follow Oxygen Therapy Orders and Provide Required Humidification
Penalty
Summary
The deficiency involves the facility’s failure to provide oxygen therapy as ordered, including required humidification, for residents with COPD and other respiratory conditions. One resident with COPD, dependence on supplemental oxygen, and congestive heart failure had a physician’s order for 4 L/min humidified oxygen to maintain oxygen saturation above 92%. Surveyors observed this resident on multiple occasions receiving 4 L/min oxygen via nasal cannula from a concentrator without the humidifier properly connected. Initially, the concentrator had a humidifier canister but no tubing connecting it to the oxygen source, and the resident reported staff told her they did not have the tubing. On a later observation, the resident again received 4 L/min oxygen without humidity, and the humidifier canister had been removed. The resident stated she had previously connected her nasal cannula directly to the humidifier instead of the concentrator due to lack of proper tubing, resulting in her not receiving oxygen. The RN stated he did not know the resident had an order for humidified oxygen and was unsure where to obtain the tubing, and the DON confirmed that if the order specifies humidified oxygen, the resident should receive humidified oxygen and that lack of humidity can cause nasal dryness and irritation. A second resident with COPD and chronic respiratory failure with hypoxia had a physician’s order for oxygen at 3 L/min via nasal cannula as needed to keep oxygen saturation above 92%. During observation, this resident was receiving oxygen at 5 L/min via nasal cannula directly from the concentrator without a humidifier or adaptor. The resident reported that the higher oxygen flow dries out her nose and affects her sinuses and stated that staff increase her oxygen flow from 3 L/min to 5 L/min when she feels short of breath. The DON stated that oxygen settings are based on physician orders in the POS and that humidifiers should be used for oxygen rates of 5 L/min or more. The facility’s oxygen therapy policy directs staff to give oxygen per physician order, but observations and interviews showed that staff did not consistently follow the ordered parameters or provide humidification as required.
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