Failure to Follow Physician Orders for Oxygen Therapy and CPAP Care
Penalty
Summary
The facility failed to ensure respiratory care and services were consistent with professional standards for two residents receiving respiratory-related treatments. For one resident with COPD and protein-calorie malnutrition, surveyors twice observed the resident receiving supplemental oxygen via nasal cannula at 2 liters per minute. Review of the resident’s clinical record and physician orders showed there was no physician order for supplemental oxygen, despite facility policy requiring a physician’s order for oxygen therapy and verification of such an order before the procedure. In an interview, the DON confirmed that the resident did not have a physician order for supplemental oxygen, and both the NHA and DON stated it was the facility’s expectation that physician orders be obtained and entered for supplemental oxygen use. For another resident with morbid obesity, obstructive sleep apnea, hypertension, and anxiety, the comprehensive care plan documented that the resident uses a CPAP, and a physician’s order directed that the CPAP mask be placed in a storage bag when not in use on every day and evening shift. The resident’s guardian reported that she visits almost daily and often finds the CPAP mask not clean and never bagged. On three separate observations of the resident’s room, surveyors found the CPAP and mask on the nightstand, not bagged, contrary to the physician’s order. In an interview, the DON stated she would expect physician orders to be followed and for the resident’s CPAP mask to have been bagged as ordered.
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