Failure to Obtain Practitioner Orders for Oxygen Therapy and Equipment Management
Penalty
Summary
The deficiency involves the facility’s failure to obtain practitioner orders for oxygen therapy and to ensure appropriate oxygen therapy management for two residents receiving supplemental O2. For one resident with diagnoses including chronic pulmonary disease, pulmonary hypertension, acute diastolic congestive heart failure, and dependence on supplemental oxygen, the admission MDS was coded for oxygen therapy, and the care plan documented that the resident would receive oxygen at 2–3 L/min as ordered. Clinical documentation, including an admission/readmission evaluation, vital signs, daily skilled notes, and nurse practitioner progress notes, showed that this resident was receiving oxygen via nasal cannula on multiple dates in November at flow rates up to 4.5 L/min. However, a review of physician orders for November revealed no orders for oxygen therapy, even though the resident was documented as being on oxygen throughout that period. Oxygen orders, including continuous oxygen at 2 L/min via nasal cannula with titration as needed and weekly tubing changes, did not appear until December. For another resident with COPD and chronic kidney disease, surveyors observed the resident on oxygen via nasal cannula at 2.5 L/min and the resident reported being placed on oxygen upon readmission from the hospital. Progress notes documented that, following concerns from the resident’s POA about low O2 readings, staff initiated oxygen at 2 L/min and then increased it to 3 L/min when saturations remained in the high 80s to mid-90s, and daily skilled notes showed the resident on oxygen on multiple dates. A nurse practitioner note also documented the resident on 2 L of oxygen. Despite this, the record review did not identify corresponding practitioner orders for oxygen therapy. Staff interviews confirmed that residents are required to have physician orders for oxygen therapy and that orders typically specify oxygen parameters, and the facility’s oxygen administration policy stated that oxygen must be administered under a physician’s order except in emergencies, with tubing and delivery devices changed weekly and as needed.
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