Deficiencies in Medication Administration and Tube Feeding Practices
Penalty
Summary
The facility failed to ensure that physician orders were followed for a resident who required nutritional support through a feeding tube. During an observation, a registered nurse did not check the placement of the feeding tube, check for residuals, or flush the tube before starting the feeding. This was confirmed by interviews with the LPN and the Director of Nursing, who stated that it is standard nursing practice to flush the tube before and after use. The nurse involved was noted to have a language barrier and was reportedly nervous during the procedure. Additionally, the facility did not accurately document the administration of physician-ordered medications for two residents. The Medication Administration Record (MAR) for one resident showed missing documentation for several scheduled medications. Interviews with the Director of Nursing and the Unit Manager revealed that the nurse responsible for administering the medications did not document them due to being busy, although she confirmed that the medications were given. The facility's policy requires immediate documentation of medication administration, which was not adhered to in this case. Furthermore, during a medication pass observation, an LPN failed to ask two residents for their pain scores before administering as-needed medications. The MAR for these residents showed that pain scores were documented without actually being assessed. The LPN claimed familiarity with the residents allowed her to assess their pain visually, but this was not in line with standard practice, as confirmed by the visiting Director of Nursing. This lack of proper documentation and assessment was a recurring issue noted during the survey.
Plan Of Correction
1: What corrective action(s) will be accomplished for those residents found to have been affected by the deficient practice; A. Resident #2, 3, 4, 5, 6 were assessed with no negative outcomes noted. B. Competencies for medication administration were completed for current licensed nurses and any new licensed nurse hired. C. Feeding competencies were completed for current licensed nurses and any new licensed nurse hired. D. Licensed nurses will document the medication administration on the Medication Administration Record post-administration. Oncoming nurses will verify off-going nurses' Medication Administration Record report prior to taking report. If any discrepancy is noted, the Director of Nursing will be made aware immediately. E. Staff education on the components of F684; this education will be provided annually and upon new hire orientation. 4: How the corrective action(s) will be monitored to ensure the deficient practice will not recur, i.e., what quality assurance program will be put into place. A. The Director of Nursing/Designee will audit daily the Medication Administration Record to ensure no medications were missed the day prior and if any were missed that appropriate interventions were done. This audit will continue weekly for four weeks then monthly for one quarter. B. The Director of Nursing/Designee will do random audits of licensed nurses and feeding residents to ensure tube placement is checked prior to administration. This audit will continue weekly for four weeks then monthly for one quarter. C. The Director of Nursing/Designee will...