Failure to Obtain Complete Oxygen Therapy Orders and Integrate Them Into Care Plans
Penalty
Summary
The deficiency involves the facility’s failure to provide safe and appropriate respiratory services by not obtaining complete physician orders for supplemental oxygen and not incorporating specific oxygen parameters into residents’ care plans. The facility’s oxygen therapy policy, last revised April 25, 2018, did not include an expectation for physician orders for supplemental oxygen. For one resident with COPD and acute kidney failure, surveyors observed the resident seated in a wheelchair at bedside receiving oxygen via nasal cannula at 2 L/min. The resident’s care plan, initiated for COPD, did not specify the amount of supplemental oxygen or the delivery method. The physician’s order for this resident directed “routine oxygen use” with oxygen saturation checks every shift and documentation of hours, liters, and source, but did not include a prescribed oxygen flow rate or the delivery device to be used. A second resident, with diagnoses including COPD and bronchiectasis, was observed seated in a wheelchair at bedside receiving oxygen via nasal cannula at 3 L/min. This resident’s COPD care plan similarly lacked documentation of the ordered oxygen flow rate and the oxygen delivery method. The physician’s order for this resident also stated “routine oxygen use” with oxygen saturation checks every shift and documentation of hours, liters, and source, but did not specify the amount of oxygen to be delivered or the delivery method. During interview, the DON acknowledged awareness of these orders, which did not contain complete parameters for oxygen therapy as required under nursing services regulations (28 Pa. Code 211.12(d)(1), (3), and (5)).
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