Deficiencies in Enteral Nutrition Management
Penalty
Summary
The facility failed to provide appropriate care and services to residents receiving tube feedings, as evidenced by deficiencies in the management of enteral nutrition for two residents. For the first resident, who was admitted with diagnoses including cerebral infarction, rheumatoid arthritis, and protein-calorie malnutrition, the physician's order for enteral feeding was incomplete. It did not specify the total volume of the formula to be administered over a 16-hour period or the mechanism for administration, such as pump or gravity. Additionally, the resident's care plan did not include the physician-ordered care and services necessary for receiving enteral nutritional support. The second resident, admitted with ischemia of the large intestines, high blood pressure, and protein-calorie malnutrition, also had an incomplete physician's order for enteral feeding. Similar to the first resident, the order did not indicate the total volume of the formula to be administered over the 16-hour period or the mechanism for administration. During an interview, the Vice President of Clinical Operations confirmed the facility's failure to provide appropriate care and services to these residents receiving tube feedings.
Plan Of Correction
Enteral nutrition order for resident #269 will be updated by the Registered Dietitian to include the mechanism of administration and total volume. Resident #121 no longer resides at the facility. All residents receiving enteral nutrition have the potential to be affected. The DON/Designee will audit all residents with enteral feed orders to ensure orders contain the total volume and mechanism of administration. The Registered Dietitian and licensed nurses will be educated on the facility policy for enteral nutrition by the DON/Designee. The DON/Designee will audit all residents with enteral feed orders weekly x 4 weeks to ensure orders contain total volume, mechanism of administration, and care plans are updated. Results of the audits will be forwarded to the center QAPI committee for review and recommendations.