Inadequate response time to support ventilator-dependent residents and respond to ventilator alarms may be considered negligence and result in the submission of a false claim.
Compliance Perspective – Ventilator Alarms
Policies/Procedures: The Compliance and Ethics Officer with the Director of Nursing will review policies and procedures involving staff response expectations needed on ventilator units.
Training: The Compliance and Ethics Officer with the Director of Nursing will ensure that staff are trained to respond in a timely manner to ventilator alarms.
Audit: The Compliance and Ethics Officer should personally observe a nursing department drill to evaluate timely responses to ventilator alarms.
The ventilator alarm sounded for 39 minutes before a nurse entered a resident’s room in response to the alarm, found the resident unresponsive, and called 911. The resident had been in the facility for almost three months with diagnoses of chronic respiratory failure, ventilator dependence, tracheostomy and Parkinson’s disease.
In its report on the incident, the MDH found the nursing home to have been negligent for its failure to intervene in a timely manner when the resident’s ventilator alarm sounded.
The nurse, when interviewed,reported that he found the resident’s ventilator well-connected when he entered the room after hearing the ventilator alarm, but he found the resident unresponsive. He said that he “initiated the emergency response system and provided respiratory support using a bag valve mask.” When paramedics arrived,the resident was pronounced deceased.
According to the MDH report,a review of the ventilator’s data indicated that there was “a large leak or disconnection of the ventilator system,” and the alarm had been sounding for nearly 40 minutes.
Nurses interviewed reported that they were short-staffed the night the resident died because the nursing home had reduced the staff on the ventilator unit.
The nursing home has since developed a staffing plan with an additional associate to continuously monitor residents’ ventilator alarms.
