Oxygen Therapy Provided Without Physician Order and Incomplete Oxygen Care Practices
Penalty
Summary
Surveyors identified a deficiency in which a resident was provided continuous supplemental oxygen via nasal cannula (NC) without a corresponding physician order following readmission from the hospital. Observations showed an oxygen concentrator in the resident’s room with attached NC tubing and a water-filled bubbler that were undated, with no indication of when they were provided or cleaned, and no “oxygen in use” sign posted outside the room. The resident, who had a diagnosis of heart failure and a BIMS score of 15 indicating she was cognitively intact, independently applied the NC and turned on the concentrator, which was set at 1.3 L/min, stating she was supposed to wear oxygen per her doctor’s order. During another observation, the resident again applied the NC and turned on the concentrator when the surveyor entered, and an LPN checked her oxygen saturation, which was 98%, but did not remove the NC or turn off the concentrator. Record review revealed an order on the treatment administration record (TAR) only to check the resident’s oxygen saturation three times daily and that supplemental oxygen was not needed if saturation was greater than 90%, but there was no physician order for oxygen via NC at 1 L/min if saturation was less than 90%, nor any orders to change the NC tubing or clean the bubbler. Staff interviews confirmed the absence of a physician order for oxygen therapy upon readmission and that CNAs relied on nurses to tell them how to set the concentrator. A CNA reported she was unaware of any specific oxygen order and only knew the resident was to have her NC on, and a CNA pocket care plan indicated the resident was to have “oxygen at all times,” without detailing parameters. The DON/infection preventionist stated the resident should have had an EMR order for oxygen via NC at 1 L/min if saturation was less than 90%, as well as TAR entries for weekly bubbler cleaning, twice-monthly NC tubing changes, and placement of an “oxygen in use” sign, which were not present. Policy review showed the facility’s oxygen therapy policy required an “OXYGEN IN USE” sign outside the room and weekly cleansing of the humidifier/bubbler, which were not being followed for this resident.
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