A Louisiana Health Department report issued following an investigation of the Iberville Oaks Nursing & Rehabilitation home in Plaquemine, Louisiana showed some troubling signs that some licensed nurse practitioners at the facility may be troublingly uneducated about specific patient care devices.
The resident which sparked the complaint that lead officials to conduct an investigation, a 62-year-old woman, was admitted to the facility on Apr. 11, 2019. When she was admitted, the Louisiana Health Department report mentions that the resident had diagnoses for Chronic Respiratory Failure with Hypoxia, Acute Respiratory Failure with Hypoxia, Diastolic Heart Failure, Morbid Obesity, Sleep Apnea, Pulmonary Hypertension, and Dyspnea.
The report also mentions that upon review of the “Skilled Nursing Facility Placement Specialist Pre-Screening Form,” there was no documentation available that the resident required respiratory assistance devices. There was, however, a handwritten Physician’s Order specifying that a BiPAP device with settings of 10/4 cubic centimeters of water was required at night and signed off on by one of the nurse practitioners designated “S4” by the Louisiana Health Department report.
Following the physician’s note, a CPAP machine was delivered to the facility for the resident. CPAP (Continuous Positive Airway Pressure) machines are not the same as BiPAP (Bilevel Positive Airway Pressure) machines. A BiPAP machine can provide two different pressures for inhalation and exhalation while a CPAP provides only one level of pressure.
The resident in the Louisiana Health Department report had treatment requirements that explicitly requested BiPAP to treat the resident’s breathing difficulty related to chronic Hypoxic Respiratory Failure. The Physician’s Orders also included treatment from Apr. 12, 2019, until June. 12, 2019. According to the Medication Administration Records, the resident claimed to have administered BiPAP device use at recommended levels overnight from Apr. 11, 2019, until June 14, 2019.
At various times from April until the day treatment ceased, the Louisiana Health Department also noted that there were accounts of the resident rejecting the CPAP treatment, even going so far as to remove the device from her room. When questioned about their conduct, eight of the licensed nurse practitioners could not identify differences between CPAP and BiPAP, stating that the two were “interchangeable” or misidentifying differences that they determined made the clarification. One nurse even gave the response that “the nurses at the facility were only responsible for turning the machine on and off.”
The resident identified by the Louisiana Health Department report noted that reparations could not be made to the patient as she had been discharged, but the facility has been ordered to properly educate their nurses on the difference between CPAP and BiPAP devices.
For more information about the dangers of neglect in nursing homes, visit the National Association of Nursing Home Attorneys’ Neglect Page.