HospitalInspections.org

Based on record review and staff interviews, it has been determined that the hospital failed to provide nursing care in accordance with accepted professional standards of nursing practice and hospital policy for patient for 1 of 2 patients who were administered oxygen, patient ID # 1.

Findings are as follows:

The hospital policy and procedure for "Oxygen Therapy and Protocol for Initiation of Non-Emergent Oxygen by RNs/RTs", revised on 3/2019, states in part:

I. PURPOSE
"To authorize Registered Nurses (RNs) and Respiratory Therapists (RTs) to order and implement a protocol for initiation and of non-emergent oxygen therapy".

II. POLICY;
"All patients with oxygen therapy will have:
a) An order specifying flow rate and delivery device.
b) Regular pulse oximetry measurements according to their ordered level of care".

Appendix A: Protocol for initiation of Non-Emergent Oxygen by RNs/RTs in Adult Patients:
-Patient has new onset of signs and or symptoms of respiratory decline ...
-Check oxygen saturation
-Oxygen saturation is 92% or less
-Initiate oxygen at 2 liters per minute via nasal cannula, contact ordering provider.

During surveyor observation of patient ID #1 on 1/7/2020 at approximately 11:15 AM the patient was noted to have a nasal cannula with oxygen being administered at 2 liters per minute. Review of the physician's orders for patient ID #1, revealed an order dated 1/5/2020 which states "Adult Non-Emergent Oxygen Protocol".

Review of the patient's flow sheet for 1/6/2020 revealed the following:
-00:15 the patients pulse oximetry (ox) was 94, not receiving oxygen.
-06:18 pulse oxygen level was 93% and receiving oxygen at 2 liters per minute.
-07:30 pulse oxygen level was 92% and receiving oxygen at 2 liters per minute.
-15:00 pulse oxygen level was 93% and receiving oxygen at 2 liters per minute.
-20:46 pulse oxygen level was 92% and the patient was not receiving the oxygen.

Additional review of the physician's orders failed to reveal an order for a specific flow rate and/or delivery device, nor did the nursing staff notify the physician when the administration of oxygen had been initiated on 1/5/2020.

During surveyor interview with staff nurse (staff A) on 1/9/2020 at 12:10 PM, she was unable to explain why there was no physicians order for an oxygen liter flow rate and could not explain why when the patient's pulse oxygen level was 92% or 93% and the patient was administered oxygen some of the time and not others.

During interview with the Clinical Manager on 1/10/2020 at 10:50 AM, she was unable to produce evidence that the staff had followed the above policy. Additionally, she was not able to explain why the patient continued to be administered oxygen without a physician's order which specified the rate of liter flow and or the delivery device.