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Based on observation, interview and record review, the hospital failed to provide respiratory medications and services as per physician's order for 2 (#4, #9) of 4 patients reviewed receiving respiratory therapy services. Findings include:

During observation of medication administration of patient #4 on 4/5/10 at approximately 1030 it was noted that the patient was not given her Spiriva inhaler treatment. Inquiry of the medication administration Staff Nurse #7 at that time revealed that Spiriva inhaler was to be administered by the Respiratory Therapist. Inquiry of patient #4 at that time revealed that the Respiratory Therapist came in earlier to give a nebulizer treatment, but the patient stated it was too soon. The patient stated that she was not offered her inhaler.

Record review of patient #4's chart revealed that Spiriva inhaler was ordered daily as well as Albuterol nebulizer treatment to be given every 6 hours. Review of the Albuterol administration record revealed that only 5 of the last 12 treatments had been administered. Interview and record review with the Respiratory Therapist Clinical Manager, on 4/5/10 at approximately 1130, revealed that many of the treatments had to be "rescheduled" (and not given per every six hour order) because they were out of the designated window of time to be given.

Review of patient #9's medical record revealed that the patient of concern was a 92 year-old female who was admitted to the hospital on 9/8/09 with cough and shortness of breath. The assessment was "1. Chronic obstructive pulmonary disease (COPD) exacerbation." Review of physician orders and medication administration records revealed that Symbicort Inhalation aerosol was ordered every 12 hours on 9/9/09 and then discontinued on 9/13/09. Symbicort was only given twice during this period of time. Spiriva one dose inhalation daily was discontinued on 9/8/09 and 9/13/09 and was documented as given 9/13/09 and 9/14/09.

Interview with the Respiratory Clinical Manager, on 4/6/10 at 1300, confirmed that the physician electronically ordered Symbicort but failed to "assign a task" as required in the electronic record to notify Respiratory Therapy Services. The patient did miss Symbicort treatments between 9/9/09 and 9/13/09. The Respiratory Clinical Manager stated that an electronic medical record fix had been submitted, but a fix was still pending. The Respiratory Therapy Department was not always notified of treatments with medications due to this problem with the electronic medical record.