Failure to Supervise Nebulizer Treatment for Cognitively Impaired Resident
Penalty
Summary
The deficiency involves a resident receiving a nebulizer treatment without required staff supervision, despite not being assessed as able to self-administer medications. During an observation, the resident was found lying in bed with a nebulizer machine running while an RN was seated at the nurses' station. After approximately two minutes, the RN entered the room, turned off the nebulizer, assessed the resident's lung sounds, and then left. The RN stated she did not normally remain with residents during their nebulizer treatments. Another RN also reported that she did not stay with residents during nebulizer treatments, but would return to check on them during the treatment. The resident had diagnoses including cognitive communication deficit, vascular dementia with moderate cognitive impairment, schizophrenia, acute bronchitis, COPD with acute exacerbation, acute cough, dyspnea, and other respiratory and circulatory symptoms. The resident’s medication orders included ipratropium-albuterol inhalation solution to be inhaled four times daily for shortness of breath and wheezing, with the medication specifically ordered to be administered by a clinician. The care plan identified a potential for impaired gas exchange related to COPD, dyspnea, rhinitis, shortness of breath, and wheezing, with interventions to administer medications as ordered. The clinical record did not show that the resident had been assessed as able to self-administer medications, and the facility’s policy for administering medications via small volume nebulizer required staff to remain with the resident for the duration of the treatment, which did not occur in this case.
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