Failure to Follow Oxygen Therapy Orders and Obtain Physician Orders for Respiratory Care
Penalty
Summary
The deficiency involves the facility’s failure to provide respiratory care consistent with physician orders and professional standards for two residents requiring oxygen therapy. For the first resident, an older male with severe cognitive impairment (BIMS score of 4), shortness of breath, and an order for continuous oxygen at 2 LPM via nasal cannula, surveyors observed him lying in bed without oxygen in place. The oxygen concentrator was running at 2 LPM, but the tubing was covered by bed sheets and not connected to the resident. His care plan included a problem of respiratory diagnosis with an intervention to administer oxygen as ordered, and active physician orders specified oxygen at 2 LPM every shift for shortness of breath. During observation and interview in the room, the CNA providing incontinent care stated she had not noticed that the resident was not on oxygen. She reported that the resident was known for removing his cannula but acknowledged she had not reported this behavior to the nurse, despite knowing he was supposed to be on continuous oxygen at 2 liters. The RN assigned to the resident stated she was aware of the continuous oxygen order but was not aware the resident was not receiving oxygen and reported she had not been to his room for hours. She stated that nurses were responsible for checking residents on oxygen to ensure they were receiving it and identified difficulty breathing as a possible negative outcome of not receiving oxygen. For the second resident, an older female with moderately impaired cognition (BIMS score of 10), COPD, and acute respiratory failure with hypoxia, the care plan documented a respiratory diagnosis with an intervention to administer oxygen as ordered. However, review of her physician order summary did not show an active order for oxygen. Surveyors observed her in the dining room with a portable oxygen tank set at zero LPM and tubing not connected, and she stated she was on oxygen and received it when provided by nurses, while her family member could not recall her being on oxygen. Later, the resident was observed on oxygen at 2 LPM. The RN caring for her confirmed the resident was on 2 LPM oxygen but could not find an order in the chart and stated there should be an order and that residents should not receive oxygen without one. The Regional Nurse Coordinator stated that residents receiving oxygen should have physician orders, that the charge nurse or person applying oxygen was responsible for obtaining orders, and that nurses were responsible for monitoring and evaluating residents on oxygen. Facility policies on oxygen administration and oxygen therapy via concentrator required verification and review of physician orders and documentation of ordered oxygen therapy in the eMAR/eTAR.
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