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Based on interview and record review, the hospital failed to ensure the RCP notified the physician as per the hospital's P&P when one of four sampled patients (Patient 3) refused the breathing treatment. This failure created the increased risk of poor health outcomes to the patients' receiving services in the hospital.

Findings:

Review of the hospital's P&P titled Respiratory Care Delivery or Treatment Scheduling effective date 9/12/24, showed in part:

* Purpose is to provide a schedule and process for therapeutic procedures provided by the Respiratory Care Department, and to ensure all respiratory care procedures and medications prescribed by a physician are administered and documented.

* Refusal and or non-delivery of ordered intervention:

- The RN who is assigned to the patient is to be notified immediately of non-delivery and the reason for non-delivery. If the patient's assigned RN is not available, the unit Charge Nurse should be informed of the missed therapy.

- If a patient consistently refuses therapy, the RCP will notify the ordering physician and Charge RT after three consecutive missed treatments.

On 9/19/24 at 0830 hours, an interview and concurrent record review was conducted with Patient Safety Lead RN 3, Chief Patient Safety Officer, Sr Principal Regulatory Compliance & Corporate Facilities, Director 1, Nurse Manager 1, and Patient Safety Lead RN 2.

Patient 3's medical record showed Patient 3 was admitted to the hospital on 9/1/24, to the medical surgical unit.

Review of the H&P examination dated 9/1/24 at 1820 hours, showed Patient 3 had a history of asthma and reported to have chronic cough and wheezing for the last several weeks. The Assessment and Plan was to give DuoNeb (combination of medications to open airways and reduce inflammation) every six hours and as needed.

Review of the physician's order dated 9/1/24 at 1938 hours, showed to give albuterol-ipratropium (DuoNeb) 2.5 - 0.5 mg per 3 ml nebulizer, give 3 ml, RT every six hours (frequency) via nebulization.

On 9/19/24 at 0920 hours, an interview and concurrent review of the medication administration record was conducted with Patient Safety Lead RN 3, Chief Patient Safety Officer, Sr Principal Regulatory Compliance & Corporate Facilities, Director 1, Nurse Manager 1, Patient Safety Lead RN 2, Director 2, and Respiratory Clinical Educator Supervisor. The medication administration record dated 9/2/24 at 0658 hours to 9/4/24 at 0717 hours, showed Patient 3 refused the nebulization treatments nine times.

Director 2 and Respiratory Clinical Educator Supervisor verified the findings and confirmed the physician had not been notified as per the hospital's P&P.