Failure to Obtain and Document Orders for Oxygen and Non-Invasive Ventilation
Penalty
Summary
The deficiency involves the facility’s failure to provide and manage respiratory care, including oxygen and non-invasive ventilation, in accordance with physician orders and professional standards for two residents. The facility’s oxygen administration policy requires that oxygen be administered under a physician’s order, that care plans identify specific oxygen interventions, and that equipment settings and monitoring be based on resident assessment and orders. The policy references CPAP as a delivery system but does not mention BiPAP. Despite this, residents were observed using oxygen and BiPAP/CPAP equipment without corresponding physician orders or documentation on the MAR/TAR. For one resident with COPD and chronic hypoxic respiratory failure, physician notes documented that long-term oxygen was needed for survival benefit, with a goal to maintain oxygen saturation above 90% when levels fell below 88%. These notes also described symptoms such as breathlessness, confusion, cough, disorientation, fatigue, headaches, tachycardia, and shortness of breath, and stated that the resident required oxygen equipment. However, there were no physician orders for oxygen therapy in the resident’s December or January physician orders or MAR/TAR. Facility self-reports and nursing notes documented that this resident was found smoking in his room while using oxygen, and that oxygen equipment was present and in use in the room without an order. Staff, including the DON and corporate RN, confirmed that there were no transcribed oxygen orders, and staff were unsure of the correct liter flow. For another resident with diagnoses including muscle wasting and atrophy, morbid obesity, obstructive sleep apnea, and restlessness and agitation, there were no physician orders for oxygen therapy, BiPAP, or CPAP in the physician orders or MAR/TAR over multiple months. Despite this, the ADON stated that the resident used oxygen with BiPAP at night, and an LPN stated that the resident used CPAP with oxygen. The LPN indicated that such use should be reflected in physician orders and in report, and that staff should be checking the level of oxygen delivery, but was uncertain whether it would appear on the MAR/TAR. When surveyors requested the resident’s orders for oxygen and BiPAP/CPAP, no orders were provided.
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