A resident with intact cognition and respiratory treatment orders received albuterol nebulizer treatments, but staff left the nebulizer tubing and mask on the resident’s refrigerator without dating, initialing, or storing them in a bag after use. The LPN confirmed she administered the treatments and did not follow the facility’s policy for labeling and storage of the nebulizer equipment.
Improper Storage of Nebulizer Equipment: A resident with asthma, prior respiratory failure, and oxygen use had a nebulizer ordered multiple times daily, but the mask was observed face down on the bedside dresser without a labeled storage bag when not in use. An RN confirmed the mask should be stored in a plastic bag, and the DON stated nebulizer masks should be cleaned and returned to a labeled bag rather than left on the dresser.
Improper Cleaning of Non-Invasive Ventilation Equipment: A resident with COPD, chronic respiratory failure, and shortness of breath used an AVAPS-AE ventilator with a full face mask. The order required the mask to be cleaned every morning and air dried, and the facility policy required daily cleaning of the mask and tubing with warm water and soap. Staff instead reported cleaning the mask with personal cleansing wipes, alcohol wipes, or water-soaked paper towels, and they had not cleaned or changed the tubing.
Nebulizer tubing and face mask were found connected to a nebulizer machine beside a resident’s bed, not dated, and not stored in a plastic bag when not in use. The resident had active nebulizer orders for ipratropium-albuterol and PRN albuterol, and the DON confirmed the tubing should be dated and properly stored per policy.
Oxygen Not Administered as Ordered: A resident with chronic respiratory failure and severe cognitive impairment was ordered continuous O2 at 2 L/min via nasal cannula, but surveyors observed the resident receiving 1 L/min on multiple occasions. An LPN stated the resident should not have been on 1 L of oxygen, and a Unit Manager confirmed the resident was receiving less than the ordered amount.
Respiratory care was not provided as ordered for a resident with COPD, chronic respiratory failure with hypoxia, emphysema, and shortness of breath. The resident’s O2 humidifier bottle was found dated and empty, and an LPN confirmed there was no water in it. The LPN stated staff should have changed the humidifier bottle and nasal cannula and cleaned the filter as scheduled.
Respiratory equipment was not properly labeled for a resident with COPD, pneumonia, CHF, and CKD who was receiving O2 at 2 L/min via NC. The resident’s oxygen tubing and oxygen canister were observed undated, and the resident did not know when the tubing had last been changed. An IP nurse confirmed the items should have been dated.
Respiratory care was not provided as ordered for two residents. Oxygen tubing and nebulizer equipment were found uncontained and undated instead of being stored in plastic bags and dated per policy, and one resident’s NC oxygen was running at 4 LPM when the order was for 3 LPM. The residents had COPD and other chronic respiratory conditions, and staff, including an LPN and the DON, confirmed the equipment and oxygen settings were not as required.
A resident with pneumonia, atrial fibrillation, and moderate cognitive impairment had unlabeled nebulizer tubing and portable oxygen tubing in his room. An LPN and the DON confirmed the tubing should have been labeled with the date it was changed, consistent with facility policy for oxygen equipment.
Improper Storage and Labeling of Nasal Cannula: A resident with orders for PRN oxygen via low-flow nasal cannula was observed multiple times with the cannula hanging over the oxygen flow meter, unlabeled, and not stored in a bag. The resident stated staff manage the cannula for her due to an upper extremity impairment, and the S2ADON/IP confirmed that when not in use, the cannula should be labeled with the change date and placed in a storage bag.
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