Oxygen Therapy Provided Without Practitioner Orders or Facility Policy
Penalty
Summary
The facility failed to ensure a resident receiving oxygen therapy had practitioner orders for oxygen use and equipment maintenance. The resident had diagnoses including nontraumatic acute subdural hemorrhage, COPD, morbid obesity due to excess calories, and obstructive sleep apnea. An admission MDS was not coded for oxygen therapy, yet the care plan addressing potential impaired gas exchange related to COPD and sleep apnea included an approach to administer oxygen as ordered starting in mid-November. Progress notes documented multiple entries over several weeks indicating the resident was on oxygen via nasal cannula at 2–3 LPM, including notations that the resident used Bi-PAP or C-PAP and required or used oxygen. Despite this documented and ongoing use of oxygen therapy, a review of physician orders for November, December, and January revealed no orders for oxygen application or equipment maintenance in the clinical record. Staff interviews confirmed that the resident was treated as being on continuous oxygen therapy, with CNAs refilling oxygen tanks and applying oxygen when the resident was out of bed, and an LPN recalling the resident being on oxygen at admission and later believed to be weaned to C-PAP only. The DON stated she was almost certain the resident had been on continuous oxygen therapy and thought it was an admission order, and also reported that the facility did not have its own oxygen therapy policy, instead following the policy of the medical supply service. This deficiency was cited under 3.1-47(a)(6).
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