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Based on staff interviews, review of policies and procedures, and medical record review, the facility failed to ensure a physician's order was in place for patient #1 for the administration oxygen while in the emergency room and after the patient was admitted to the medical/surgical unit at the facility. Oxygen was titrated between 2 and 5 liters via nasal cannula without a documented physician order.
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Findings were:
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Facility policy titled, "Verbal and Written Orders-General" stated in part,
"Orders for patient treatment and medications, including the administration of medications, shall be carried out only when given by a qualified physician, surgeon, nurse practitioner podiatrist or other person duly licensed or authorized to prescribe by the state of Texas and who has been approved as a member of the medical staff of this hospital.
*All orders of medication and treatment shall be written into the electronic medical record (EMR) of the patient and signed by the ordering provider.
*All orders for treatment shall include the type of treatment, specific requirements of the treatment (such as wet to dry dressing, etc.) and the frequency of treatment."

Facility policy/procedure titled, "Respiratory Department Guidelines" stated in part,
"All procedures, diagnostic and therapeutic, will be initiated by order of a licensed independent practitioner only.
*Verbal orders to an RN, written by the RN, and countersigned by a physician may be accepted to initiated procedures.
*Members of Respiratory Services can receive and write verbal and/or telephone orders from a physician when the order pertains to accepted Cardiopulmonary Services Practice Procedures only.
*Therapists/Technicians may act under standing orders or as an assistant in emergency situations, i.e., CPR.

Criteria for the Receipt of Verbal Orders by Respiratory Services:
*Only the following Respiratory Services staff are allowed to accept and write verbal telephone orders from a physician:
Department Manager
Supervisors
Therapists and technicians
*Verbal/telephone orders must be written in the patient's medical record and countersigned by the ordering physician within 24 hours."

Review of the patient's physician orders list revealed there was NO Physician Order to administer Oxygen. There was no physician order to titrate Oxygen as per O2 saturation level.

Patient #1 Progress Notes revealed patient was administered oxygen via nasal cannula without a physician order and oxygen L/M (liter/minute) titrated between 2-5 liters by nursing and respiratory staff on the following dates and times.
*Date 02/01/20
Times: 01:40 O2 Sat 90%
01:58 O2 L/M 3
04:06 O2 Sat. 93%
06:15 O2 L/M 3
07:08 O2 L/M 3
07:08 O2 Sat 94%
11:03 O2 L/M 3
15:28 O2 L/M 2, O2 Sat 93%
20:00 O2 L/M 5, O2 Sat 92%

*Date: 02/02/20
Times: 00:06 O2 L/M 5, O2 Sat 93%
04:02 O2 L/M 5, O2 Sat 94%

L.T. (staff #1) Quality/Risk Compliance Manager was interviewed the morning of 01/12/2021. She stated, "The patient came in via ambulance on 2 L oxygen per nasal cannula. Usually there is an order for oxygen, but it was missed. The order for oxygen goes into the admitting orders and usually we have orders to titrate oxygen depending on the patient's O2 saturation."

The above findings were confirmed by Staff # 1 on the afternoon of 01/12/2021.