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Based on interview and clinical record review, the facility provided nasal cannula oxygen to seven of 10 sampled patients, Patient #3, #4, #5, #6, #7, #8, and #10 without a physician order. The facility's census was 279 patients.

Findings:

The clinical record review for Patient #10 was completed on 12/01/11. The clinical record review revealed the 56-year-old patient was admitted to the facility on 10/02/11 at 6:10 P.M. The clinical record review revealed a history and physical dictated on 10/03/11 at 11:00 A.M. that stated the patient was admitted for respiratory failure, desaturation and fever. The history and physical stated the patient was fine until the night of admission when after having a large meal he/she developed shortness of breath. The history and physical stated there was respiratory failure most likely due to aspiration-pneumonia and that the patient had "significant" gastroesophageal reflux disease and chronic obstructive pulmonary disease. The history and physical described his/her past medical history as significant for diabetes, hypertension, pulmonary nodule, and carbon dioxide retention.

The clinical record review revealed nursing notes that stated the patient was given on 10/02/11 at 10:15 P.M. six liters of oxygen by nasal cannula. The nasal cannula is a device used to deliver supplemental oxygen to a patient who needs it. Rather than a mask, this device consists of a plastic tube which fits behind the ears, and a set of two prongs which are placed in the nostrils.

The clinical record review revealed nursing documentation on 10/03/11 at 4:12 A.M. the patient was on 5.5 liters oxygen and on 7:15 A.M. at six liters oxygen by nasal cannula.

The clinical record review revealed nursing documentation for 10/04/11 at 7:21 A.M., 9:00 A.M., 11:30 A.M., 11:54 A.M., 3:23 P.M., 7:46 P.M., 8:00 P.M, and on 10/05/11 at 7:09 A.M., and 2:45 P.M., and on 10/06/11 at 8:00 A.M., the patient was on two liters oxygen by nasal cannula.

The clinical record review did not reveal a physician's order for the oxygen.

On 11/30/11 at 4:55 P.M. in an interview, Nurse Manager #1 said he/she was unable to find a physician's order for the oxygen by nasal cannula.



21893

The clinical record for Patient #3 was reviewed on 11/29/11. The patient was admitted to the facility on 11/25/11 with a diagnosis of exacerbation of chronic obstructive pulmonary disease. The medical record contained documentation the patient was on two to four liters of oxygen per nasal cannula from 4:00 A.M. on 11/25/11 through 3:58 P.M. on 11/30/11. The clinical record lacked documentation of an order for oxygen use until 5:10 P.M. on 11/30/11. This was confirmed by Nurse Manager #1 on 12/01/11 at 10:30 A.M.

The clinical record for Patient #4 was reviewed on 11/30/11. The patient was admitted to the facility on 11/15/11 with diagnoses of dyspnea (trouble breathing) and chronic obstructive pulmonary disease. The clinical record contained an order for oxygen use of two liters per nasal cannula. The clinical record contained documentation the patient was receiving 2.5 liters of oxygen per nasal cannula from 8:45 A.M. through 12:15 P.M. on 11/18/11 and three liters of oxygen per nasal cannula from 6:00 A.M. on 11/20/11 through 12:00 A.M. on 11/21/11. The clinical record contained an order for three liters of oxygen per nasal cannula on 11/21/11 at 6:53 A.M. The clinical record contained documentation the patient was receiving two liters of oxygen per nasal cannula from 8:00 A.M. on 11/21/11 through 4:10 A.M. on 11/22/11. This was confirmed by Nurse Manager #1 on 12/01/11 at 10:30 A.M.

The clinical record for Patient #5 was reviewed on 11/30/11. The patient was admitted to the facility on 11/16/11 with mitral valve disease. The clinical record contained documentation the patient was receiving one to five liters of oxygen per nasal cannula from 8:15 A.M. on 11/17/11 through 4:00 P.M. on 11/19/11. The clinical record lacked documentation of an order for oxygen use until 11/21/11 at 6:02 P.M. This was confirmed by Nurse Manager #1 on 12/01/11 at 10:30 A.M.

The clinical record for Patient #6 was reviewed on 11/30/11. The patient was admitted to the facility on 11/17/11 with a diagnosis of respiratory failure. The clinical record contained documentation the patient was receiving two to six liters of oxygen per nasal cannula from 10:30 P.M. on 11/17/11 through 12:20 P.M. on 11/30/11. The clinical record lacked documentation of an order for oxygen use. This was confirmed by Nurse Manager #2 on 11/30/11 at 2:00 P.M.

The clinical record for Patient #7 was reviewed on 12/01/11. The patient was admitted to the facility on 10/25/11 with diagnoses of change in mental status, high blood pressure, end stage renal disease, diabetes, and atrial fibrillation. The clinical record contained documentation the patient was receiving two to three liters of oxygen per nasal cannula from 1:00 A.M. on 10/25/11 through 1:48 P.M. on 11/02/11, two to four liters of oxygen per nasal cannula from 4:48 P.M. on 11/06/11 through 4:00 A.M. on 11/09/11, two to three liters of oxygen per nasal cannula from 11:30 A.M. on 11/09/11 through 8:45 P.M. on 11/13/11, two to three liters of oxygen per nasal cannula from 8:15 A.M. on 11/14/11 through 2:12 P.M. on 11/21/11, and four to six liters of oxygen per nasal cannula from 3:15 P.M. on 11/26/11 through 4:23 A.M. on 11/27/11. The clinical record lacked documentation of any orders for oxygen usage during these times. The clinical record contained an order for four liters of oxygen per nasal cannula at 7:08 A.M. on 11/27/11. The clinical record contained documentation the patient was receiving only two liters of oxygen per nasal cannula on 11/28/11 at 12:00 P.M. and 8:00 P.M. The clinical record contained documentation the patient was receiving only three liters of oxygen per nasal cannula from 11:15 A.M. to 3:56 P.M. on 11/29/11, from 7:25 A.M. to 11:00 P.M. on 11/30/11, and from 8:36 A.M. to 9:00 A.M. on 12/01/11. The medical record lacked additional orders for oxygen use or titration of the oxygen usage. This was confirmed by Nurse Manager #1 on 12/01/11 at 10:30 A.M.

The clinical record for Patient #8 was reviewed on 12/01/11. The patient was admitted to the facility on 09/27/11 with a diagnosis of chronic obstructive pulmonary disease exacerbation. The clinical record contained documentation that the patient was receiving four liters of oxygen per nasal cannula on 09/27/11 at 6:38 P.M., six liters of oxygen per nasal cannula from 10:55 P.M. through 1:00 A.M. on 09/28/11, four liters of oxygen per nasal cannula at 2:30 A.M. on 09/28/11, and two liters of oxygen from 4:00 A.M. to 6:50 A.M. on 09/28/11. The clinical record lacked an order for oxygen usage until 09/28/11 at 10:47 A.M. This was discussed with the Director of Quality on 12/01/11 at 2:45 P.M.

These findings substantiate complaint number OH00062808.

Based on clinical record review, policy review, and interview, the facility failed to have results of discharge planning, as assessed by social work, discussed with Patient #10. The sample size was 10 patients, the facility's census was 279 patients.

Findings:

The clinical record review for Patient #10 was completed on 12/01/11. The clinical record review revealed the 56-year-old patient was admitted to the facility on 10/02/11 at 6:10 P.M. The clinical record review revealed a history and physical dictated on 10/03/11 at 11:00 A.M. that stated the patient was admitted for respiratory failure, desaturation and fever. The history and physical stated the patient was fine until the night of admission when after having a large meal he/she developed shortness of breath. The history and physical stated there was respiratory failure most likely due to aspiration-pneumonia and that the patient had "significant" gastroesophageal reflux disease and chronic obstructive pulmonary disease. The history and physical described his/her past medical history as significant for diabetes, hypertension, pulmonary nodule, and carbon dioxide retention.

The clinical record review revealed a nursing note dated 10/02/11 that stated the patient planned to return home with his/her wife after discharge. The note stated he/she needed help caring for himself, but denied having help at home.

The clinical record review revealed a physician's order dated 10/02/11 at 8:00 A.M. that ordered for a social service consult to answer questions about home care and oxygen. The clinical record review did not reveal any documentation as evidence this was done.

Review of the facility's policy "Discharge Planning/Continuity of Care," last reviewed 10/07/08, stated under social worker/nurse case manager responsibilities, the social worker/nurse case manager "documents needs, referrals, teaching efforts and interventions in the medical progress notes as often as activity warrants .." .

On 11/30/11 at 1:28 P.M. in an interview, the Director of Case Management stated because there weren't any discharge needs identified, a social worker would not have visited with the patient and/or family, and there would not be a note. He/she said given patient's comorbidities (diabetes, chronic obstructive pulmonary disease, hypertension, obesity, and severe gastroesophageal reflux disease) maybe an in-person visit should have been made to the patient.

This finding substantiates complaint number OH00062808.

Based on interview and clinical record review, the facility failed to provide Patient #10 oxygen by BiPAP as ordered by the physician, and provided seven of 10 patients reviewedwith oxygen by nasal cannula which was not physician ordered. (Patient's 3, 4, 5, 6, 7, 8, and 10) The facility's census was 279 patients.

Findings:

The clinical record review for Patient #10 was completed on 12/01/11. The clinical record review revealed the 56-year-old patient was admitted to the facility on 10/02/11 at 6:10 P.M. The clinical record review revealed a history and physical dictated on 10/03/11 at 11:00 A.M. that stated the patient was admitted for respiratory failure, desaturation and fever. The history and physical stated the patient was fine until the night of admission when after having a large meal he/she developed shortness of breath. The history and physical stated there was respiratory failure most likely due to aspiration-pneumonia and that the patient had "significant" gastroesophageal reflux disease and chronic obstructive pulmonary disease. The history and physical described his/her past medical history as significant for diabetes, hypertension, pulmonary nodule, and carbon dioxide retention.

The clinical record review revealed an arterial blood gas was tested on 10/02/11 at 3:36 P.M. The result was a pH of 7.4 and a pCO2 of 55 (normal range being 34 to 46 millimeters mercury).

The clinical record review revealed a physician's order dated 10/02/11 at 8:30 P.M. that stated the patient was to have BiPAP at bedtime when he/she sleeps. BiPAP stands for bi-level positive airway pressure. It is a breathing apparatus/mask that helps people get more air into their lungs.

The clinical record review revealed nursing notes that stated the patient was given on 10/02/11 at 10:15 P.M. six liters of oxygen by nasal cannula. The nasal cannula is a device used to deliver supplemental oxygen to a patient who needs it. Rather than a mask, this device consists of a plastic tube which fits behind the ears, and a set of two prongs which are placed in the nostrils.

The clinical record review revealed nursing documentation on 10/03/11 at 4:12 A.M. the patient was on 5.5 liters oxygen and on 7:15 A.M. at six liters oxygen by nasal cannula.

The clinical record review did not reveal where a BiPAP was applied to the patient during the early hours of 10/03/11.

On 11/30/11 at 2:30 P.M. in an interview, Respiratory Therapy Director #1 confirmed the BiPAP was never applied to the patient during the early hours of 10/03/11. He/she said it was likely the third shift staff came on duty without having seen the order for the BiPAP.




21893

The clinical record for Patient #3 was reviewed on 11/29/11. The patient was admitted to the facility on 11/25/11 with a diagnosis of exacerbation of chronic obstructive pulmonary disease. The medical record contained documentation the patient was on two to four liters of oxygen per nasal cannula from 4:00 A.M. on 11/25/11 through 3:58 P.M. on 11/30/11. The clinical record lacked documentation of an order for oxygen use until 5:10 P.M. on 11/30/11. This was confirmed by Nurse Manager #1 on 12/01/11 at 10:30 A.M.

The clinical record for Patient #4 was reviewed on 11/30/11. The patient was admitted to the facility on 11/15/11 with diagnoses of dyspnea (trouble breathing) and chronic obstructive pulmonary disease. The clinical record contained an order for oxygen use of two liters per nasal cannula. The clinical record contained documentation the patient was receiving 2.5 liters of oxygen per nasal cannula from 8:45 A.M. through 12:15 P.M. on 11/18/11 and three liters of oxygen per nasal cannula from 6:00 A.M. on 11/20/11 through 12:00 A.M. on 11/21/11. The clinical record contained an order for three liters of oxygen per nasal cannula on 11/21/11 at 6:53 A.M. The clinical record contained documentation the patient was receiving two liters of oxygen per nasal cannula from 8:00 A.M. on 11/21/11 through 4:10 A.M. on 11/22/11. This was confirmed by Nurse Manager #1 on 12/01/11 at 10:30 A.M.

The clinical record for Patient #5 was reviewed on 11/30/11. The patient was admitted to the facility on 11/16/11 with mitral valve disease. The clinical record contained documentation the patient was receiving one to five liters of oxygen per nasal cannula from 8:15 A.M. on 11/17/11 through 4:00 P.M. on 11/19/11. The clinical record lacked documentation of an order for oxygen use until 11/21/11 at 6:02 P.M. This was confirmed by Nurse Manager #1 on 12/01/11 at 10:30 A.M.

The clinical record for Patient #6 was reviewed on 11/30/11. The patient was admitted to the facility on 11/17/11 with a diagnosis of respiratory failure. The clinical record contained documentation the patient was receiving two to six liters of oxygen per nasal cannula from 10:30 P.M. on 11/17/11 through 12:20 P.M. on 11/30/11. The clinical record lacked documentation of an order for oxygen use. This was confirmed by Nurse Manager #2 on 11/30/11 at 2:00 P.M.

The clinical record for Patient #7 was reviewed on 12/01/11. The patient was admitted to the facility on 10/25/11 with diagnoses of change in mental status, high blood pressure, end stage renal disease, diabetes, and atrial fibrillation. The clinical record contained documentation the patient was receiving two to three liters of oxygen per nasal cannula from 1:00 A.M. on 10/25/11 through 1:48 P.M. on 11/02/11, two to four liters of oxygen per nasal cannula from 4:48 P.M. on 11/06/11 through 4:00 A.M. on 11/09/11, two to three liters of oxygen per nasal cannula from 11:30 A.M. on 11/09/11 through 8:45 P.M. on 11/13/11, two to three liters of oxygen per nasal cannula from 8:15 A.M. on 11/14/11 through 2:12 P.M. on 11/21/11, and four to six liters of oxygen per nasal cannula from 3:15 P.M. on 11/26/11 through 4:23 A.M. on 11/27/11. The clinical record lacked documentation of any orders for oxygen usage during these times. The clinical record contained an order for four liters of oxygen per nasal cannula at 7:08 A.M. on 11/27/11. The clinical record contained documentation the patient was receiving only two liters of oxygen per nasal cannula on 11/28/11 at 12:00 P.M. and 8:00 P.M. The clinical record contained documentation the patient was receiving only three liters of oxygen per nasal cannula from 11:15 A.M. to 3:56 P.M. on 11/29/11, from 7:25 A.M. to 11:00 P.M. on 11/30/11, and from 8:36 A.M. to 9:00 A.M. on 12/01/11. The medical record lacked additional orders for oxygen use or titration of the oxygen usage. This was confirmed by Nurse Manager #1 on 12/01/11 at 10:30 A.M.

The clinical record for Patient #8 was reviewed on 12/01/11. The patient was admitted to the facility on 09/27/11 with a diagnosis of chronic obstructive pulmonary disease exacerbation. The clinical record contained documentation that the patient was receiving four liters of oxygen per nasal cannula on 09/27/11 at 6:38 P.M., six liters of oxygen per nasal cannula from 10:55 P.M. through 1:00 A.M. on 09/28/11, four liters of oxygen per nasal cannula at 2:30 A.M. on 09/28/11, and two liters of oxygen from 4:00 A.M. to 6:50 A.M. on 09/28/11. The clinical record lacked an order for oxygen usage until 09/28/11 at 10:47 A.M. This was discussed with the Director of Quality on 12/01/11 at 2:45 P.M.

These findings substantiate complaint number OH00062808.

Based on interview and clinical record review, the facility provided nasal cannula oxygen to seven of 10 sampled patients, Patient #3, #4, #5, #6, #7, #8, and #10 without a physician order. The facility's census was 279 patients.

Findings:

The clinical record review for Patient #10 was completed on 12/01/11. The clinical record review revealed the 56-year-old patient was admitted to the facility on 10/02/11 at 6:10 P.M. The clinical record review revealed a history and physical dictated on 10/03/11 at 11:00 A.M. that stated the patient was admitted for respiratory failure, desaturation and fever. The history and physical stated the patient was fine until the night of admission when after having a large meal he/she developed shortness of breath. The history and physical stated there was respiratory failure most likely due to aspiration-pneumonia and that the patient had "significant" gastroesophageal reflux disease and chronic obstructive pulmonary disease. The history and physical described his/her past medical history as significant for diabetes, hypertension, pulmonary nodule, and carbon dioxide retention.

The clinical record review revealed nursing notes that stated the patient was given on 10/02/11 at 10:15 P.M. six liters of oxygen by nasal cannula. The nasal cannula is a device used to deliver supplemental oxygen to a patient who needs it. Rather than a mask, this device consists of a plastic tube which fits behind the ears, and a set of two prongs which are placed in the nostrils.

The clinical record review revealed nursing documentation on 10/03/11 at 4:12 A.M. the patient was on 5.5 liters oxygen and on 7:15 A.M. at six liters oxygen by nasal cannula.

The clinical record review revealed nursing documentation for 10/04/11 at 7:21 A.M., 9:00 A.M., 11:30 A.M., 11:54 A.M., 3:23 P.M., 7:46 P.M., 8:00 P.M, and on 10/05/11 at 7:09 A.M., and 2:45 P.M., and on 10/06/11 at 8:00 A.M., the patient was on two liters oxygen by nasal cannula.

The clinical record review did not reveal a physician's order for the oxygen.

On 11/30/11 at 4:55 P.M. in an interview, Nurse Manager #1 said he/she was unable to find a physician's order for the oxygen by nasal cannula.



21893

The clinical record for Patient #3 was reviewed on 11/29/11. The patient was admitted to the facility on 11/25/11 with a diagnosis of exacerbation of chronic obstructive pulmonary disease. The medical record contained documentation the patient was on two to four liters of oxygen per nasal cannula from 4:00 A.M. on 11/25/11 through 3:58 P.M. on 11/30/11. The clinical record lacked documentation of an order for oxygen use until 5:10 P.M. on 11/30/11. This was confirmed by Nurse Manager #1 on 12/01/11 at 10:30 A.M.

The clinical record for Patient #4 was reviewed on 11/30/11. The patient was admitted to the facility on 11/15/11 with diagnoses of dyspnea (trouble breathing) and chronic obstructive pulmonary disease. The clinical record contained an order for oxygen use of two liters per nasal cannula. The clinical record contained documentation the patient was receiving 2.5 liters of oxygen per nasal cannula from 8:45 A.M. through 12:15 P.M. on 11/18/11 and three liters of oxygen per nasal cannula from 6:00 A.M. on 11/20/11 through 12:00 A.M. on 11/21/11. The clinical record contained an order for three liters of oxygen per nasal cannula on 11/21/11 at 6:53 A.M. The clinical record contained documentation the patient was receiving two liters of oxygen per nasal cannula from 8:00 A.M. on 11/21/11 through 4:10 A.M. on 11/22/11. This was confirmed by Nurse Manager #1 on 12/01/11 at 10:30 A.M.

The clinical record for Patient #5 was reviewed on 11/30/11. The patient was admitted to the facility on 11/16/11 with mitral valve disease. The clinical record contained documentation the patient was receiving one to five liters of oxygen per nasal cannula from 8:15 A.M. on 11/17/11 through 4:00 P.M. on 11/19/11. The clinical record lacked documentation of an order for oxygen use until 11/21/11 at 6:02 P.M. This was confirmed by Nurse Manager #1 on 12/01/11 at 10:30 A.M.

The clinical record for Patient #6 was reviewed on 11/30/11. The patient was admitted to the facility on 11/17/11 with a diagnosis of respiratory failure. The clinical record contained documentation the patient was receiving two to six liters of oxygen per nasal cannula from 10:30 P.M. on 11/17/11 through 12:20 P.M. on 11/30/11. The clinical record lacked documentation of an order for oxygen use. This was confirmed by Nurse Manager #2 on 11/30/11 at 2:00 P.M.

The clinical record for Patient #7 was reviewed on 12/01/11. The patient was admitted to the facility on 10/25/11 with diagnoses of change in mental status, high blood pressure, end stage renal disease, diabetes, and atrial fibrillation. The clinical record contained documentation the patient was receiving two to three liters of oxygen per nasal cannula from 1:00 A.M. on 10/25/11 through 1:48 P.M. on 11/02/11, two to four liters of oxygen per nasal cannula from 4:48 P.M. on 11/06/11 through 4:00 A.M. on 11/09/11, two to three liters of oxygen per nasal cannula from 11:30 A.M. on 11/09/11 through 8:45 P.M. on 11/13/11, two to three liters of oxygen per nasal cannula from 8:15 A.M. on 11/14/11 through 2:12 P.M. on 11/21/11, and four to six liters of oxygen per nasal cannula from 3:15 P.M. on 11/26/11 through 4:23 A.M. on 11/27/11. The clinical record lacked documentation of any orders for oxygen usage during these times. The clinical record contained an order for four liters of oxygen per nasal cannula at 7:08 A.M. on 11/27/11. The clinical record contained documentation the patient was receiving only two liters of oxygen per nasal cannula on 11/28/11 at 12:00 P.M. and 8:00 P.M. The clinical record contained documentation the patient was receiving only three liters of oxygen per nasal cannula from 11:15 A.M. to 3:56 P.M. on 11/29/11, from 7:25 A.M. to 11:00 P.M. on 11/30/11, and from 8:36 A.M. to 9:00 A.M. on 12/01/11. The medical record lacked additional orders for oxygen use or titration of the oxygen usage. This was confirmed by Nurse Manager #1 on 12/01/11 at 10:30 A.M.

The clinical record for Patient #8 was reviewed on 12/01/11. The patient was admitted to the facility on 09/27/11 with a diagnosis of chronic obstructive pulmonary disease exacerbation. The clinical record contained documentation that the patient was receiving four liters of oxygen per nasal cannula on 09/27/11 at 6:38 P.M., six liters of oxygen per nasal cannula from 10:55 P.M. through 1:00 A.M. on 09/28/11, four liters of oxygen per nasal cannula at 2:30 A.M. on 09/28/11, and two liters of oxygen from 4:00 A.M. to 6:50 A.M. on 09/28/11. The clinical record lacked an order for oxygen usage until 09/28/11 at 10:47 A.M. This was discussed with the Director of Quality on 12/01/11 at 2:45 P.M.

These findings substantiate complaint number OH00062808.

Based on interview and clinical record review, the facility failed to provide Patient #10 oxygen by BiPAP as ordered by the physician, and provided seven of 10 patients reviewedwith oxygen by nasal cannula which was not physician ordered. (Patient's 3, 4, 5, 6, 7, 8, and 10) The facility's census was 279 patients.

Findings:

The clinical record review for Patient #10 was completed on 12/01/11. The clinical record review revealed the 56-year-old patient was admitted to the facility on 10/02/11 at 6:10 P.M. The clinical record review revealed a history and physical dictated on 10/03/11 at 11:00 A.M. that stated the patient was admitted for respiratory failure, desaturation and fever. The history and physical stated the patient was fine until the night of admission when after having a large meal he/she developed shortness of breath. The history and physical stated there was respiratory failure most likely due to aspiration-pneumonia and that the patient had "significant" gastroesophageal reflux disease and chronic obstructive pulmonary disease. The history and physical described his/her past medical history as significant for diabetes, hypertension, pulmonary nodule, and carbon dioxide retention.

The clinical record review revealed an arterial blood gas was tested on 10/02/11 at 3:36 P.M. The result was a pH of 7.4 and a pCO2 of 55 (normal range being 34 to 46 millimeters mercury).

The clinical record review revealed a physician's order dated 10/02/11 at 8:30 P.M. that stated the patient was to have BiPAP at bedtime when he/she sleeps. BiPAP stands for bi-level positive airway pressure. It is a breathing apparatus/mask that helps people get more air into their lungs.

The clinical record review revealed nursing notes that stated the patient was given on 10/02/11 at 10:15 P.M. six liters of oxygen by nasal cannula. The nasal cannula is a device used to deliver supplemental oxygen to a patient who needs it. Rather than a mask, this device consists of a plastic tube which fits behind the ears, and a set of two prongs which are placed in the nostrils.

The clinical record review revealed nursing documentation on 10/03/11 at 4:12 A.M. the patient was on 5.5 liters oxygen and on 7:15 A.M. at six liters oxygen by nasal cannula.

The clinical record review did not reveal where a BiPAP was applied to the patient during the early hours of 10/03/11.

On 11/30/11 at 2:30 P.M. in an interview, Respiratory Therapy Director #1 confirmed the BiPAP was never applied to the patient during the early hours of 10/03/11. He/she said it was likely the third shift staff came on duty without having seen the order for the BiPAP.




21893

The clinical record for Patient #3 was reviewed on 11/29/11. The patient was admitted to the facility on 11/25/11 with a diagnosis of exacerbation of chronic obstructive pulmonary disease. The medical record contained documentation the patient was on two to four liters of oxygen per nasal cannula from 4:00 A.M. on 11/25/11 through 3:58 P.M. on 11/30/11. The clinical record lacked documentation of an order for oxygen use until 5:10 P.M. on 11/30/11. This was confirmed by Nurse Manager #1 on 12/01/11 at 10:30 A.M.

The clinical record for Patient #4 was reviewed on 11/30/11. The patient was admitted to the facility on 11/15/11 with diagnoses of dyspnea (trouble breathing) and chronic obstructive pulmonary disease. The clinical record contained an order for oxygen use of two liters per nasal cannula. The clinical record contained documentation the patient was receiving 2.5 liters of oxygen per nasal cannula from 8:45 A.M. through 12:15 P.M. on 11/18/11 and three liters of oxygen per nasal cannula from 6:00 A.M. on 11/20/11 through 12:00 A.M. on 11/21/11. The clinical record contained an order for three liters of oxygen per nasal cannula on 11/21/11 at 6:53 A.M. The clinical record contained documentation the patient was receiving two liters of oxygen per nasal cannula from 8:00 A.M. on 11/21/11 through 4:10 A.M. on 11/22/11. This was confirmed by Nurse Manager #1 on 12/01/11 at 10:30 A.M.

The clinical record for Patient #5 was reviewed on 11/30/11. The patient was admitted to the facility on 11/16/11 with mitral valve disease. The clinical record contained documentation the patient was receiving one to five liters of oxygen per nasal cannula from 8:15 A.M. on 11/17/11 through 4:00 P.M. on 11/19/11. The clinical record lacked documentation of an order for oxygen use until 11/21/11 at 6:02 P.M. This was confirmed by Nurse Manager #1 on 12/01/11 at 10:30 A.M.

The clinical record for Patient #6 was reviewed on 11/30/11. The patient was admitted to the facility on 11/17/11 with a diagnosis of respiratory failure. The clinical record contained documentation the patient was receiving two to six liters of oxygen per nasal cannula from 10:30 P.M. on 11/17/11 through 12:20 P.M. on 11/30/11. The clinical record lacked documentation of an order for oxygen use. This was confirmed by Nurse Manager #2 on 11/30/11 at 2:00 P.M.

The clinical record for Patient #7 was reviewed on 12/01/11. The patient was admitted to the facility on 10/25/11 with diagnoses of change in mental status, high blood pressure, end stage renal disease, diabetes, and atrial fibrillation. The clinical record contained documentation the patient was receiving two to three liters of oxygen per nasal cannula from 1:00 A.M. on 10/25/11 through 1:48 P.M. on 11/02/11, two to four liters of oxygen per nasal cannula from 4:48 P.M. on 11/06/11 through 4:00 A.M. on 11/09/11, two to three liters of oxygen per nasal cannula from 11:30 A.M. on 11/09/11 through 8:45 P.M. on 11/13/11, two to three liters of oxygen per nasal cannula from 8:15 A.M. on 11/14/11 through 2:12 P.M. on 11/21/11, and four to six liters of oxygen per nasal cannula from 3:15 P.M. on 11/26/11 through 4:23 A.M. on 11/27/11. The clinical record lacked documentation of any orders for oxygen usage during these times. The clinical record contained an order for four liters of oxygen per nasal cannula at 7:08 A.M. on 11/27/11. The clinical record contained documentation the patient was receiving only two liters of oxygen per nasal cannula on 11/28/11 at 12:00 P.M. and 8:00 P.M. The clinical record contained documentation the patient was receiving only three liters of oxygen per nasal cannula from 11:15 A.M. to 3:56 P.M. on 11/29/11, from 7:25 A.M. to 11:00 P.M. on 11/30/11, and from 8:36 A.M. to 9:00 A.M. on 12/01/11. The medical record lacked additional orders for oxygen use or titration of the oxygen usage. This was confirmed by Nurse Manager #1 on 12/01/11 at 10:30 A.M.

The clinical record for Patient #8 was reviewed on 12/01/11. The patient was admitted to the facility on 09/27/11 with a diagnosis of chronic obstructive pulmonary disease exacerbation. The clinical record contained documentation that the patient was receiving four liters of oxygen per nasal cannula on 09/27/11 at 6:38 P.M., six liters of oxygen per nasal cannula from 10:55 P.M. through 1:00 A.M. on 09/28/11, four liters of oxygen per nasal cannula at 2:30 A.M. on 09/28/11, and two liters of oxygen from 4:00 A.M. to 6:50 A.M. on 09/28/11. The clinical record lacked an order for oxygen usage until 09/28/11 at 10:47 A.M. This was discussed with the Director of Quality on 12/01/11 at 2:45 P.M.

These findings substantiate complaint number OH00062808.