Health inspection·March 7, 2024

F 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, and record review, the facility failed to ensure that a resident who needs respiratory care was provided with professional standards of practice for 1 of 4 residents (expired Resident #1) reviewed for oxygen in that: Residents Affected - Few LVN A failed to document baseline pulse, respiratory rate, O2 saturation, and lung sounds before and after a nebulizer treatment for Resident #1. This failure could place residents who receive respiratory care at risk of developing respiratory complications and a decreased qualify of care. The findings included: Record review of Resident #1's face sheet dated [DATE] reflected he was initially admitted on [DATE]. Resident #1's relevant diagnoses were chronic obstructive pulmonary disease, acute and chronic respiratory failure with hypoxia (the absence of enough oxygen in the tissues to sustain bodily function), hypertension, and vascular dementia (brain damage caused by multiple strokes). Record review of Resident #1's MDS quarterly assessment dated [DATE] reflected he had a BIMS score of 6 which indicated he was severely impaired. Record review of Resident #1's comprehensive care plan dated [DATE] reflected he had altered respiratory status/difficulty breathing related to chronic obstructive pulmonary disease. The goal was that Resident #1 had no complications related to shortness of breath. The intervention was to administer medication/puffers as ordered and to maintain a clear airway by encouraging resident to clear own secretions with effective coughing. If secretions cannot be cleared, suction as ordered/required to clear secretions. Record review of Resident #1's Albuterol Sulfate Inhalation Nebulization Solution dated [DATE] reflected 3 ml inhale orally via nebulizer every 6 hours as needed PRN QID/wheezing. Record review of Resident #1's respiratory order dated [DATE] reflected to monitor respirations, pulse, O2 saturations and lung sounds prior to nebulizer treatments, scheduled or PRN. Directions, as needed document lung sounds as 0-clear, 1-rales, 2-rhonchi, 3-diminished, 4-wheezing, 5-crackles, 6-other. Document the actual time it prior to administration of nebulizer treatment to set up and assess the resident. Record review of Resident #1's respiratory order dated [DATE] reflected to assess after Page 1 of 3 675162 675162 03/07/2024 Briarcliff Nursing and Rehabilitation Center 3201 N Ware Rd McAllen, TX 78501

F 0695 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few administering Nebulizer treatment as needed. Document lung sounds as 0-clear, 1-rales, 2-rhonchi, 3-diminished, 4-wheezing, 5-crackles, 6-other. Document the actual time it prior to administration of nebulizer treatment to set up and assess the resident. In an interview on [DATE] at 2:30 p.m., LVN A said on [DATE] Resident #1's family member went looking for her to tell her Resident #1 had a lot of phlegm, she said it was around 9:50 p.m. LVN A said Resident #1's family member told her he had elevated his head. LVN A said she checked Resident #1's orders on PCC to see if he had anything ordered or PRN. She said Resident #1 had an order for nebulizer treatments (PRN). LVN A said she first suctioned Resident #1 and then administered a nebulizer treatment. LVN A said she performed an assessment which consisted of checking his oxygen level, respirations, and pulse before and after she administered the nebulizer treatment. LVN A said Resident #1's oxygen level was at 97% (while receiving oxygen via nasal cannula) both prior and after nebulizer treatment. LVN A said Resident #1 requested to terminate treatment after 10 minutes. LVN A said LVN B was with her while she suctioned and administered the nebulizer treatment to Resident #1. LVN A said Resident #1's family member was standing by the door looking in while he was receiving the nebulizer treatment. LVN A said after the treatment Resident #1 sounded better and had no more phlegm. LVN A said Resident #1 was resting comfortably after nebulizer treatment and family member stayed with him. LVN A said she forgot to document the assessment and nebulizer treatment on PCC, as required. LVN A said she did not do a 24-hour report on Resident #1 having phlegm because by the time she administered the nebulizer treatment/suction on Resident #1 she had already reviewed the 24-hour reports with incoming charge nurse (RN C). LVN A said she inform RN C verbally of the suction/nebulizer treatment on Resident #1 and for her to monitor him. LVN A said Resident #1 would regularly get congested that was why they kept the nebulizer as PRN. LVN said there were no negative effects on Resident #1 for her not documenting his assessments and nebulizer treatment because it was PRN, and it could be given every 4 to 6 hours. A phone interview on [DATE] at 3:15 p.m., LVN B (PRN nurse) said on [DATE] LVN A called her to assist her with the nebulizer machine because she was having trouble making it work. LVN B said there was nothing wrong with the nebulizer machine, she said it was the tubing and they got it working. LVN B said that night she had been assigned to the 100 hall and LVN A had been assigned to the 200 hall. LVN B said witnessed LVN A perform the suction and administer the nebulizer treatment to Resident #1. LVN B said Resident #1 had phlegm but was not in distress. LVN B said Resident #1's family member was standing by the door watching them. LVN B said she and LVN A stayed with Resident #1 while he received the nebulizer treatment. LVN B said after the nebulizer treatment Resident #1 was resting comfortably and family member stayed at his bedside. LVN B said she did not know if LVN A documented the before and after assessments and nebulizer treatment on PCC. In an interview on [DATE] at 4:36 p.m., the DON she had conducted group and 1 to 1 in-service with all her nursing staff on the importance of documenting quarterly or as needed. The DON said LVN A had attended in-services on documenting. The DON said, if it's not documented, it's like they didn't do it. She said the possible negative effect of no documenting a resident's respiratory assessment would not be known until the next treatment. Record review of facility's policy on Oral Inhalation Administration dated [DATE] reflected: Policy: To allow for safe, accurate, and effective administration of medication using an oral inhaler (with or without a spacer/chamber) or nebulizer. 675162 Page 2 of 3 675162 03/07/2024 Briarcliff Nursing and Rehabilitation Center 3201 N Ware Rd McAllen, TX 78501

F 0695 Nebulizer: Level of Harm - Minimal harm or potential for actual harm 4. Obtain baseline pulse, respiratory rate, and lunch sounds. 20. Obtain post-treatment pulse, respiratory rate and lung sounds and document finding on the MAR. Residents Affected - Few 675162 Page 3 of 3