Failure to Follow Oxygen Orders and Proper Nebulizer Equipment Handling
Penalty
Summary
The deficiency involves failures in safe and appropriate respiratory care, including improper oxygen administration and nebulizer equipment handling for multiple residents. For one resident with COPD receiving scheduled Ipratropium-Albuterol nebulizer treatments four times daily, surveyors observed the nebulizer mask and tubing stored in a clear bag with the medicine chamber still wet and containing liquid drops, contrary to the facility’s nebulizer policy that requires rinsing and allowing the nebulizer to air-dry. The medication administration record showed a morning dose documented as given and an early afternoon dose documented as not given on the day of observation. Another resident, cognitively intact and dependent on staff for several ADLs, was found lying in bed without oxygen in place; the nasal cannula and tubing were positioned by the wall and out of reach. The resident stated she was supposed to use oxygen all the time and reported that a CNA had assisted with changing her shirt, during which the oxygen was removed and not replaced for about an hour. When staff were alerted, the resident’s oxygen saturation was measured at 87–88% before oxygen was reapplied. A third cognitively intact resident, dependent on supplemental oxygen, was observed receiving oxygen at 4 L/min via concentrator and nasal cannula. Review of the medical record with the ADON showed a physician’s order for oxygen at 2 L/min, indicating the oxygen flow being delivered did not match the provider’s order. The facility’s oxygen policy did not include directives on following provider orders or monitoring liters of oxygen to be used.
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