Oxygen equipment was not consistently dated or labeled for several residents receiving O2 via NC, and staff confirmed the facility expected tubing and humidifiers to be changed weekly and labeled after each change. In addition, one resident receiving O2 had only a weaning parameter order in the chart, with no order specifying the liters, route, or frequency of oxygen administration, and the DON confirmed the missing order.
Respiratory care was not provided in accordance with physician orders for three residents receiving O2. Two residents had O2 tubing and humidifiers that were not dated or labeled as required, and one had an empty humidifier bottle. Another resident was observed on an O2 flow rate below the ordered level, and when staff increased the flow to the ordered setting, the equipment made a whistling sound. An LPN, unit manager, and DON were aware of the concerns.
Oxygen Safety and Signage Deficiencies: Two residents were observed receiving oxygen therapy with missing oxygen-in-use signage on their room doors. One resident also had an unsecured portable O2 tank standing on the floor at the bedside instead of being secured in a cart, stand, or bracket. Facility policy required oxygen warning signs on the room door and clear identification that oxygen was in use.
Oxygen was not administered as ordered for one resident, whose flow meter was found set below the ordered rate until staff reviewed the order and adjusted it. In a separate finding, another resident's nasal cannula was observed out of the nostrils and the oxygen tubing was not labeled, and an RN acknowledged both issues when questioned.
A resident with obstructive sleep apnea and insomnia had a CPAP machine at the bedside, but the record lacked physician orders and a care plan for its use and care. The resident reported that only some staff knew how to use the CPAP correctly, so it was not always used, and the DON confirmed the absence of CPAP-related orders, interventions, and staff tasks in the chart.
The facility was cited for inconsistent supplemental oxygen management for two residents. One resident was observed on oxygen without an active order in the chart, and an LPN confirmed the lack of an order. Another resident was observed receiving 3 L/min via NC despite an order for 2 L/min continuous oxygen, and there was no oxygen care plan in place; the Unit Manager confirmed the mismatch and absence of care planning.
Respiratory care was not provided in accordance with orders and facility policy for two residents. One resident receiving oxygen had tubing and a humidifier bottle that were not labeled as required, the humidifier bottle was dated, and the oxygen flow rate did not match the physician order. Another resident’s nebulizer mask was repeatedly observed without a date or time label and was not stored in a clean bag, but instead was left on the bedside table, pillow, and side of the bed.
Oxygen was provided at rates that did not match the residents’ orders. One resident’s concentrator was observed at 4.5 l/min even though the order was for 3 l/min, and no humidification bottle was present despite documentation showing weekly changes. Another resident’s oxygen was observed at 3.5 l/min while the active order was for 2 l/min. An LPN confirmed the ordered rates, and the DON acknowledged the concern.
Respiratory and tracheostomy care was not provided as ordered for a resident with a trach. Surveyors observed the resident on oxygen via trach, then later found the resident receiving 4 L O2 even though the order was for 3 L continuous via NC. They also found a size 7 trach in use with extra size 7 tubes at the bedside, but no smaller trach size present as ordered. The RN confirmed the oxygen order after reviewing it, and the DON acknowledged the smaller trach was not at the bedside.
Respiratory care was not provided as ordered for multiple residents. A nebulizer mask was left on a soiled tray and an unused oxygen cylinder was kept in a room without an oxygen order; another resident’s oxygen tubing and humidifier bottle were unlabeled and the nasal cannula was left uncovered; one resident was receiving 1.5 L instead of the ordered 2 L; and another resident’s oxygen tubing was on the floor while the concentrator was running, so oxygen was not being delivered as ordered.
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