Failure to Provide Ordered BiPAP and Properly Order/Document Oxygen Therapy
Penalty
Summary
The deficiency involves the facility’s failure to provide respiratory services in accordance with professional standards of practice for two residents who required such care. One resident was admitted with a diagnosis that included obstructive sleep apnea and had a hospital discharge summary directing continuation of BiPAP for sleep. Review of the resident’s December Treatment Administration Record showed that the BiPAP was not ordered or documented as administered until three days after admission, resulting in three nights without the prescribed BiPAP therapy. In an interview, the Administrator confirmed that facility staff did not administer the resident’s BiPAP during those three nights following admission. For another resident, admitted with COPD, asthma, and chronic myeloid leukemia, the medical record documented use of oxygen at 3 LPM via nasal cannula and a history and physical noting acute on chronic hypoxic hypercapnic respiratory failure, COPD, asthma, and home oxygen use of 2–3 liters, as well as recent community-acquired pneumonia and acute hypoxic respiratory failure while hospitalized prior to admission. The vital sign section of the electronic medical record showed intermittent use of oxygen; however, review of the December and January physician’s orders revealed no orders for oxygen therapy, tubing changes, humidification, oxygen saturation goals, or basic care related to oxygen therapy. The facility’s oxygen therapy policy required verification of a medical doctor order including liter flow and type of O2 delivery device. During an interview, the DON confirmed that the MAR and TAR contained no documentation of oxygen usage, tubing changes, or humidification for this resident.
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