Failure to Notify Physician of Resident's Tube Feeding Refusal
Penalty
Summary
The facility failed to notify the physician of a resident's refusal of tube feedings, which is a requirement under §483.10(g)(14). The resident, who was admitted with diagnoses including quadriplegia, depression, and anxiety, had an order for enteral feeding with Nutren 2.0. The medication administration record (MAR) indicated multiple instances where the resident refused the feedings, marked with the number two (2) on specific dates. Despite these refusals, the nursing progress notes did not document any notification to the physician regarding the resident's refusal of the enteral tube feedings. The facility's policies, including "Guidelines for Notifying Physicians of Clinical Problems" and "Enteral Tube Feeding via Continuous Pump," require that medical care problems and negative consequences of tube use be communicated to the medical staff in a timely manner. However, the Director of Nursing confirmed during an interview that the facility did not notify the physician about the resident's refusal of tube feedings. This oversight is a violation of the regulatory requirement to inform the physician of significant changes in the resident's treatment needs.
Plan Of Correction
R50 no longer resides in the facility. A retroactive review of all residents with tube feedings will be completed to ensure that any required notifications have been completed. The DON/Designee will educate all licensed nursing staff on the "Guidelines for Notifying Physicians of Clinical Problems" policy for physician notification. The DON or designee will audit all residents with tube feeds for physician notification of refusals daily x3, then five residents twice weekly x 3, then weekly 8 weeks. Audit results will be reviewed through QAPI for further recommendation.