Oxygen Therapy Provided Without Physician Order
Penalty
Summary
The deficiency involves the facility’s failure to obtain and document a physician’s order for oxygen therapy for Resident #12 despite ongoing use of oxygen. Resident #12 was readmitted with diagnoses including polyosteoarthritis, chronic pain syndrome, and schizoaffective disorder bipolar type, and the initial admission record noted the resident was alert and oriented x4 and on 2 LPM oxygen via nasal cannula. On the day of readmission, nursing documentation showed the resident’s O2 saturation was 86% on room air and improved to 94% after being placed on 2 LPM oxygen, and the resident was instructed to keep the oxygen on. The initial care plan included multiple focus areas such as cognition, skin, ADLs, nutrition, pain, falls, and infection, but did not include oxygen use as a focus area with interventions. Subsequent documentation, including a physician readmission note, stated that the resident was on 2 LPM oxygen via nasal cannula and that the resident reported improved breathing. However, review of the clinical record revealed no evidence of a physician order for oxygen use, including no orders for replacement of nasal cannula or oxygen tubing, cleaning and filling of oxygen concentrators, or parameters for oxygen administration. An IDT-BIMS note documented that the resident was cognitively intact, able to repeat words and correctly state the year and month. Multiple observations over several days showed the resident using oxygen at 2 LPM via nasal cannula in her room, sometimes with the cannula improperly positioned, and the resident reported that she had been on oxygen for a while, initially on an as-needed basis, and had been told to keep it on. Interviews with the ADON, several LPNs, and the DON consistently confirmed that residents using oxygen are required to have a physician order specifying the oxygen rate/dose and parameters, and that staff are expected to obtain such an order if a resident is found on oxygen without one. One LPN stated that in the resident’s current hall there were only two residents with oxygen orders and that this did not include Resident #12, and during a concurrent record review and observation, she confirmed there was no oxygen order for this resident despite active use of oxygen at 2 LPM. The DON also confirmed that the clinical record did not show an order for oxygen use for Resident #12, and facility policy on physician orders required that drugs and biologicals, including treatments and procedures, be administered only upon written, dated, and signed orders from an authorized prescriber.
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