A clogged breathing tube can have dire consequences.  If a breathing tube is obstructed with either food or bodily secretions, then the pathway oxygen is also blocked.  Being unable to breath and decreased oxygen levels for even a brief period of time can result in permanent brain damage, stroke and in certain instances, even death.  Other risks include respirational pneumonia, which is usually due to food or other substances getting into the lungs creating an infection often leading to death.  When a nursing aide is unable to spend sufficient time in assisting with eating and drinking it is possible for the food and liquids to be either lodged in the tracheal tube or the resident’s airway and lungs.

An obstructed breathing tube is not the only complication surrounding tracheotomy tubes.  If the tubes are not properly maintained and cleaned, then there could be a risk of infection.  It is important that the nursing staff is adequately trained and use sterile technique to minimize this risk.

It is the responsibility of the nursing home to ensure that a resident receives quality care at the highest level practicable.  The nursing home resident and their tracheotomy tube must be properly monitored by the nursing staff and adequate care must be provided.  All residents will require different and particular care needs when monitoring of their respiratory system.  This will depend on the hydration, humidity, infection and nutrition of the patient as well as the patient’s ability to cough and the patient’s level of competence.  No matter how much care a resident requires, the nursing home is responsible the necessary care or transferring the resident to a facility that is capable of providing the care and treatment.

Nursing homes across Minnesota have an obligation to comply with minimum care standards established by state and federal regulations.   Many times, injuries occurring to residents of Minnesota nursing homes, assisted living and other types of elder care facilities is due to a corporate organization which is focused on maximizing profits at the expense of safety.   Many asphyxiation and tracheotomy tube incidents resulting in serious injury or deaths could have been prevented with increased numbers of attentive and well qualified staff providing additional supervision.

Minnesota law requires that a nursing home must have on duty at all times a sufficient number of qualified nursing personnel, including registered nurses, licensed practical nurses, and nursing assistants to meet the needs of the residents at all nurses’ stations, on all floors, and in all buildings if more than one building is involved.  This includes relief duty, weekends, and vacation replacements.

Minnesota Rule 4658.0015 states that a nursing home must operate and provide services in compliance with all applicable federal, state, and local laws, regulations, and codes, and with accepted professional standards and principles that apply to professionals providing services in a nursing home.

Minnesota Rule 4658.0105 mandates that a nursing home must ensure that direct care staff is able to demonstrate competency in skills and techniques necessary to care for residents’ needs, as identified through the comprehensive resident assessments and described in the comprehensive plan of care and are able to perform their assigned duties.

Federal regulation 42 CFR §483.25 (h) establishes a duty for the nursing home to ensure that the resident receives adequate supervision and assistive devices to prevent accidents:

42 CFR §483.25 (h) Accidents. The facility must ensure that—

(1) The resident environment remains as free of accident hazards as is possible; and

(2) Each resident receives adequate supervision and assistance devices to prevent accidents.

Minnesota Statute 626.5572, Subd. 3.  Accident.

“Accident” means a sudden, unforeseen, and unexpected occurrence or event which:

(1) is not likely to occur and which could not have been prevented by exercise of due care; and
(2) if occurring while a vulnerable adult is receiving services from a facility, happens when the facility and the employee or person providing services in the facility are in compliance with the laws and rules relevant to the occurrence or event.

Despite the state and federal regulations designed to protect vulnerable adult, there are still an unacceptably high number of respirational pneumonia, dislodged or clogged trachetomy tube incidents in nursing homes due to inadequate staffing and training.