Failure to Manage Oxygen Therapy per Orders and Facility Policy
Penalty
Summary
The deficiency involves the facility’s failure to provide safe and appropriate respiratory care by not obtaining required physician orders for oxygen, not dating oxygen tubing when changed, and not maintaining humidifier water bottles as specified in facility policy. During observation, one resident was found in bed on continuous oxygen at 3 LPM via nasal cannula with undated tubing that was tangled around the bedside rail; the LPN stated tubing should be free of tangles and dated weekly. This resident’s record showed diagnoses including COPD, pleural effusion, and palliative care, with an active order for continuous oxygen at 2–3 LPM and instructions to check the humidifier water level every shift. Another resident with a diagnosis including cerebral infarction was observed in bed on 3 LPM oxygen via nasal cannula with undated tubing; the LPN confirmed tubing should be dated. The active physician order for this resident specified oxygen at 3 LPM via nasal cannula for SpO2 below 90% every shift for shortness of breath, but there was no care plan formulated for oxygen use. A third resident with diagnoses including hemiplegia, hemiparesis, and muscle wasting was observed in bed on 3 LPM oxygen via nasal cannula with an empty humidifier bottle and undated tubing; the LPN stated tubing should be dated and humidifier water checked and replaced when empty. The physician order indicated continuous oxygen at 2 LPM via nasal cannula, and the comprehensive care plan documented oxygen therapy related to ineffective gas exchange and interstitial pulmonary disease with an intervention to give oxygen as ordered. A fourth resident with diagnoses including hemiplegia, hemiparesis, and paroxysmal atrial fibrillation was observed in bed on 2.5 LPM oxygen via nasal cannula with undated tubing, and review of the active physician order sheet showed no order for oxygen use, although the comprehensive care plan included a plan for oxygen usage. The DON and a nursing consultant later confirmed that oxygen tubing should be dated when changed, humidifier bottles should be checked and refilled as needed, and that residents using oxygen should have a physician order and be care planned, consistent with facility policies on oxygen therapy and physician orders.
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