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Based on medical record review and interview, the facility failed to ensure respiratory therapy followed physician's orders for one (#2) of five patients reviewed.

The findings included:

Medical record review revealed patient #2 was admitted to the facility on August 3, 2011, with complaints of weakness, decreased activity, and foul smelling urine. Continued medical record review revealed the patient had a past medical history which included Frequent Urinary Tract Infections, Depression, Chronic Obstructive Pulmonary Disease, Chronic Pain, Dementia, Hypertension, and Chronic Foley Catheter. Further review revealed the patient was treated and discharged to a skilled nursing facility on August 9, 2011.

Review of physician's orders dated August 3, 2011, revealed "Percussion vest TID (three times daily) for 20 minutes with respiratory treatment". Continued review of physician's orders dated August 6, 2011, revealed "Albuterol Sulfate 0.63 mg inhalation nebulizer treatment QID (four times daily) with home percussion vest".

Review of respiratory notes dated August 6, 2011, revealed "Patient took off vest before time was up". Continued review of respiratory notes dated August 7, 2011, at 2:00 p.m., revealed "Could not locate vest portion of vest airway clearance machine". Further review of respiratory therapy notes dated August 7, 2011, at 7:00 p.m., revealed "Used flutter valve in place of missing vest". Continued review of respiratory notes dated August 8, 2011, revealed "Patient has vest machine in room but there is no vest". Further review of respiratory notes revealed no documentation the percussion vest was used from the time of the initial order on August 3, 2011 until documentation on August 6, 2011 stating the patient was not cooperative with use of the vest.

Review of physician's progress notes dated August 8, 2011, revealed "...daughter complained that vest was not being used...".

Interview with the Risk Manager on September 21, 2011, at 3:30 p.m., in the conference room, revealed it had been reported to the department the vest was missing. Continued interview revealed the room was searched to no avail and the laundry, which is off-site, was called but had not found anything in the linen. Further interview revealed Respiratory Therapy was assisting the daughter to replace the vest. Continued interview revealed the vest was replaced the next day (August 9, 2011). Further interview confirmed the patient was ordered to have respiratory treatments with the percussion vest on August 3, 2011, and there is no documentation the vest was utilized until August 6, 2011, when a second order for its use was written.