Uncontained Nasal Cannulas and Oxygen Tubing When Not in Use
Penalty
Summary
The deficiency involves the facility’s failure to ensure nasal cannulas and oxygen tubing were properly contained when not in use, as required by facility policy and staff expectations. For one resident, R11, who had diagnoses including hypertensive heart disease with heart failure, cardiomyopathy, atrial fibrillation, dementia, and dependence on supplemental oxygen, the care plan and physician orders documented a need for continuous oxygen at 2 L/min via nasal cannula and staff assistance with oxygen use. Despite this, surveyors observed R11’s nasal cannula and tubing lying on top of the bed sheets, not contained in a plastic bag, while the oxygen concentrator remained turned on and connected to the uncontained tubing. R11 was not in the room at the time and was later observed in the dining room without oxygen in place. Multiple observations on the same day confirmed that R11’s nasal cannula and tubing remained uncontained on the bed, even though an Enhanced Barrier Precautions (EBP) sign was posted on the door. When the surveyor and an RN (V16) entered the room, the RN confirmed that the tubing and nasal cannula were lying on the bed and acknowledged that they should always be contained in a plastic bag when not in use. The RN initially stated that the tubing and cannula should be contained and changed weekly, then later stated that they had made a mistake. Other staff, including a unit manager/CNA (V22), the Administrator (V1), and the DON (V2), stated that nasal cannulas and oxygen tubing should be stored in labeled plastic bags when not in use, replaced if found uncontained, and handled with appropriate hand hygiene and, in EBP rooms, with gowns and gloves. A similar situation was observed for another resident, R98, who had diagnoses including COPD, chronic respiratory failure with hypoxia, emphysema, pulmonary embolism, and dependence on supplemental oxygen, with physician orders for continuous oxygen at 2 L/min via nasal cannula. Surveyors observed R98’s nasal cannula sitting on the bed, attached to tubing and an oxygen concentrator, not in use by the resident and not contained in a bag, while the resident was in the dining room without oxygen in place. An LPN (V3), the ADON (V36), and the DON (V2) each stated that nasal cannulas should be stored in plastic bags when not in use and replaced if found uncontained. Facility policies on respiratory equipment and oxygen therapy devices, as well as inservice records, documented that respiratory equipment, including nasal cannulas, should be stored in storage bags when not in use and that staff are responsible for following these procedures to prevent contamination.
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