Failure to Obtain Physician Order and Notify Physician for Initiation of Oxygen Therapy
Penalty
Summary
The deficiency involves the facility’s failure to notify the physician and obtain a medical order when a resident experienced a significant change in condition requiring oxygen (O2) therapy. The resident was admitted with Parkinson’s disease, dementia, and epilepsy. On multiple observations over several days, the resident was seen in a wheelchair and in bed with a nasal cannula in place, receiving O2 at 2 liters per minute via a portable oxygen concentrator and then an oxygen concentrator. Record review showed an oxygen saturation of 98% on O2, but there was no corresponding physician order for oxygen use in the resident’s medical record as of the date reviewed. During interviews, an LPN reported that O2 therapy had been initiated after staff noted the resident desaturating into the low 80% range and appearing increasingly weak, but acknowledged there was no physician order authorizing O2. The LPN also stated that staff were not consistently documenting the resident’s O2 use, O2 saturation levels, or desaturation episodes, and could not identify documentation of ongoing monitoring, physician notification, or clinical follow-up related to the resident’s O2 needs. The ADON stated she was unaware the resident had been receiving O2 until informed shortly before her interview and confirmed there was no documentation of physician notification, an order, or supervisory review. The DON stated the physician or medical director should have been notified on the first day O2 was initiated, and the medical director stated there should have been a standing order for O2 and that he expected to be notified of any decrease in O2 saturation, but he was not notified in this case.
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