Failure to Revise Respiratory Care Plan After New Oxygen and AVAPS Orders
Penalty
Summary
The deficiency involves the facility’s failure to timely revise and implement a comprehensive care plan related to respiratory care for one resident following changes in condition and new treatment orders. Facility policy on “Comprehensive Person-Centered Care Plans,” revised March 2022, states that assessments are ongoing and care plans are to be revised as information about the resident and the resident’s condition changes. The resident had a medical history that included toxic encephalopathy, COPD with exacerbation, acute and chronic respiratory failure with hypoxia and hypercapnia, pneumonia, and dementia. A Minimum Data Set assessment completed on February 20, 2026, documented a BIMS score of 14, indicating the resident was cognitively able to participate in care discussions. Physician orders dated February 17, 2026, directed continuous oxygen at 3 L/min via nasal cannula with SpO2 to be maintained between 88–92% every shift, and an additional order at 11:00 p.m. the same day for assistance with applying a Trilogy V60 (AVAPS) device at bedtime with specified ventilator settings, including documentation of any refusal of AVAPS every evening and night shift and PRN for COPD. During an interview on March 3, 2026, the resident stated an inability to differentiate between CPAP, BiPAP, and AVAPS machines. Review of the resident’s care plan showed no timely update or revision of goals and specific interventions addressing the recent hospitalization, change in mental status, assistance with applying AVAPS, the resident’s refusal of AVAPS, the frequency of AVAPS application, or maintaining oxygen saturation between 88–92%, contrary to facility policy and regulatory requirements.
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