Inadequate Documentation of Enteral Feeding and Hydration
Penalty
Summary
The facility failed to ensure that a resident, who required total nutrition and hydration via a gastrostomy tube, received adequate nutritional and hydration care consistent with their comprehensive assessment. The resident, who had severe cognitive impairment, dysphagia, malnutrition, and diabetes, was supposed to receive specific amounts of enteral feeding and water flushes as per physician orders. However, the Medication Administration Record (MAR) showed multiple instances of missing documentation and discrepancies between the documented and ordered amounts of nutrition and hydration. The facility's policies on enteral feedings and intake and output monitoring were not adhered to, as evidenced by the incomplete and inconsistent documentation in the MAR. The records showed that the resident did not consistently receive the prescribed amounts of Glucerna 1.5 and water flushes, with several instances of blanks or incorrect amounts recorded. This lack of accurate documentation could lead to adverse effects such as electrolyte imbalances, dehydration, and diarrhea, as noted by the Registered Nurse Manager. Interviews with facility staff, including the Director of Nursing and the Registered Dietitian, revealed a lack of clarity and responsibility regarding the monitoring of fluid intake records. The Registered Dietitian, who worked remotely, did not notice the discrepancies in the MAR until they were pointed out during the survey. The facility administrator was also unaware of the documentation issues, indicating a breakdown in communication and oversight within the facility's nutritional care processes.
Plan Of Correction
Plan of Correction: Approved February 7, 2025 1. Flush order was clarified with RD. All nursing staff will be educated about following orders and calculating correct math. 2. All residents with tube feed can potentially be affected. House-wide audit done on all tube feed orders. Any discrepancies were corrected. 3. Policy Enteral tube-flushing and Med admin-Enteral tube were reviewed and no changes made. IDT and licensed staff will be educated on the above policies specifically related to calculation of tube feeding administered and water flushes. 4. Weekly audits of tube feeding administered and water flushes x 4, bi-weekly audits x 2 and monthly audits until corrected to be done by nursing administration. The DON or designee will report the findings to the Quality Assurance Performance Improvement Committee.