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Based on record review and interview, the facility staff failed to have a director of respiratory care who is a doctor in 1 of 1 respiratory care department.

Findings include:

Review of hospital organizational revealed Manager of Respiratory Therapy D as the director of Respiratory Therapy.

Interview on 9/10/2019 at 8:52 AM, Director of Quality and Safety I stated, "(Manager of Respiratory Therapy D) is a registered nurse and has a Masters degree in Health Administration. Does not have a background in respiratory therapy, but can use the hospitalists, pulmonologists, or respiratory therapists for any questions."

Interview on 9/5/2019 at 10:15 AM, Chief Executive Officer F, was asked about direct supervision of the respiratory department, stated, "We do not have a physician who is dedicated to be the medical director position to directly oversee the Respiratory Care Services."

Based on record review and interview, facility staff failed to obtain physician orders for 3 of 3 inpatients using CPAP [Continuous Positive Airway Pressure] therapy (Patient #3, Patient #4, Patient #5), in a total sample of 12 patients reviewed.

Findings include:

Review of facility policy "Respiratory Therapy CPAP/BiPAP [Continuous Positive Airway Pressure] Ventilation," dated 8/2018, revealed "All patients requiring mask CPAP/BiPAP will have an appropriate physician order including desired CPAP/BiPAP level(s) and oxygen saturation to maintain. ...Pressure levels(s) and oxygen flow will be set to desired levels per physician order. Insure that all parameters are in accordance with physician's orders."

Per medical record review, Patient #3 was admitted to the facility on 8/21/2019 for depression and a history of COPD [Chronic Obstructive Pulmonary Disease] and respiratory failure. Per Respiratory Therapy progress notes, Patient #3 was using CPAP at night. There were no orders for CPAP in Patient #3's record.

Per medical record review, Patient #4 was admitted to the facility on 9/4/2019 for weakness with a history of Obstructive Sleep Apnea (OSA). Per Respiratory Therapy notes, Patient #4 received CPAP therapy on 9/4/2019 at 10:44 PM. There were no orders for CPAP therapy in Patient #4's record.

Per medical record review, Patient #5 was admitted to the facility on 9/4/2019 for nausea, vomiting and back pain. Review of Patient #5's History and Physical exam revealed "...past medical history of: ...OSA (uses CPAP)..." Respiratory Therapy documented the use of CPAP for Patient #5 on 9/5/2019 at 12:45 AM. There were no orders for CPAP in Patient #5's medical record.

During an interview on 9/5/2019 at 10:45 AM, Respiratory Therapist C stated "there aren't any orders... I think we should have" orders for patients using CPAP therapy.