Failure to Provide Functional Bi-Pap and Required Respiratory Support
Penalty
Summary
The deficiency involves the facility’s failure to provide required respiratory care and equipment for a resident with significant pulmonary and cardiac comorbidities. The resident had diagnoses including COPD, respiratory failure, CHF, and atrial fibrillation, required continuous oxygen, and needed extensive assistance with ADLs. The resident’s care plan documented the need for oxygen at all times and monitoring for signs and symptoms of respiratory distress. Following a hospitalization for hypercapnia and pneumonia, the hospital discharge instructions specified that the resident was to receive 3 L of oxygen continuously and use Bi-Pap at night. Upon discharge from the hospital, the resident’s primary care physician documented that the resident was supposed to be on Bi-Pap when he returned to the facility and that the facility had told the hospital they had a functioning Bi-Pap available. However, the physician noted that as of the time of his dictation, the resident had not been placed on Bi-Pap and that the facility would need to see if they could acquire one. The physician also documented that an ABG was needed to evaluate CO2 retention and that, if the facility could not obtain a Bi-Pap in a timely manner and the resident’s CO2 continued to rise, he would likely need to return to the emergency room. A subsequent health status note recorded that an ABG drawn at the facility showed a CO2 level of 85, and the resident was sent to the emergency room. Hospital records from the readmission documented that the resident presented with elevated CO2 and was diagnosed with mucous plugging, left pleural effusion, acute hypercapnic respiratory failure, and decreased responsiveness. The hospital noted that the resident had been discharged two days earlier with orders for Bi-Pap ventilation and that the hospital had kept him an extra day so the facility could arrange Bi-Pap, but for some reason he did not have access to a Bi-Pap machine after return. A pulmonology consult documented recurrent acute hypercapnic respiratory failure requiring Bi-Pap and noted that the resident’s mentation was already improving with Bi-Pap. Facility staff interviews revealed that the facility had informed the hospital they had an in-house Bi-Pap, but when staff attempted to set it up, they could not program the settings and were later told by the equipment company that the machine was no longer functional. Staff stated a replacement Bi-Pap was expected that evening, but one nurse reported she did not know until the next morning that the new machine had not been delivered and that the resident had been without Bi-Pap overnight. The facility was unable to provide a Respiratory Care Policy applicable to this practice.
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