Failure to Obtain Oxygen Orders and Maintain Clean Nasal Cannula for Resident on Oxygen
Penalty
Summary
The deficiency involves the facility’s failure to provide safe and appropriate respiratory care, including oxygen therapy, in accordance with physician orders, the comprehensive care plan, and professional standards of practice for a male resident with severe cognitive impairment and multiple medical diagnoses. Record review showed that the resident’s Minimum Data Set (MDS), comprehensive care plan, and physician order summary contained no indication or orders for oxygen therapy as of mid-January, despite the resident being observed with an oxygen concentrator and humidifier running at 2 L. A physician order for oxygen at 2 L via nasal cannula every shift was only entered into the record after state surveyor intervention. The facility’s own policy required that special needs, including respiratory care, be provided consistent with physician orders and the care plan, and that RNs and LPNs manage medical conditions by following physician orders and reporting changes in condition. On multiple observations, the resident was found in bed with an oxygen concentrator and humidifier on and set at 2 L, but with the nasal cannula off and thrown over the opposite side of the bedside table, with the prongs that insert into the nostrils touching the carpeted floor. On a subsequent observation, the same nasal cannula, labeled with a date several days earlier, was on the resident while the concentrator remained set at 2 L. The resident was not interviewable. In interviews, the LVN caring for the resident on the observed days could not explain how or when the oxygen was initiated, suggested a verbal order might have been missed and not entered into the electronic health record, and acknowledged that a nasal cannula found on the floor should be replaced to prevent infection. The DON stated that oxygen should be administered according to physician orders, that nurses are responsible for ensuring orders and settings are correct, and that a nasal cannula touching the floor must be changed due to infection control concerns, consistent with the facility’s infection prevention and control program and equipment protocols.
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