Facility Failed to Honor Resident's Refusal of G-Tube Feeding
Penalty
Summary
The facility violated a resident's right to refuse treatment when they continued to provide artificial nutrition through a G-tube for 24 days after the resident had signed a Physician Order for Life Sustaining Treatment (POLST) indicating his wish to refuse such treatment. The resident, who was capable of making his own healthcare decisions, had a BIMS score of 15, indicating intact cognitive function. Despite the resident's clear wishes documented on the POLST form, the facility continued to administer enteral feeding, causing the resident distress, frustration, and pain. The resident had been readmitted to the facility with a G-tube due to dysphagia and aspiration risks. However, he expressed a desire to eat regular food and drink liquids, and he was non-compliant with the NPO diet by consuming oral snacks and beverages. The nursing progress notes documented the resident's distress and his explicit statements about wanting the G-tube removed. The Director of Nursing confirmed that the facility failed to honor the resident's wishes as documented in the POLST, continuing the G-tube feedings against his will for nearly a month.
Plan Of Correction
F 578 Request/Refuse/Dscntnue Trmnt; Formite Adv Dir How corrective action(s) will be accomplished for those residents found to have been affected by the deficient practice: The resident's rights were followed on 2/10/25 when the diet order was updated by the physician to align with the resident's wishes. The Gastrointestinal Tube was removed on 3/11/25 during an outpatient appointment. How the facility will identify other residents having the potential to be affected by the same deficient practice and what corrective action will be taken: Any resident who updates their POLST (Physician Orders for Life-Sustaining Treatment) to include no artificial means of nutrition following the surgical implementation of a Gastrointestinal Tube may be affected by this practice. No other residents were affected by this practice. On 3/13/25, Medical Records completed a facility-wide audit of resident POLSTs, identifying and correcting any issues. What measures will be put into place or what systematic changes the facility will make to ensure that the deficient practice does not reoccur: On 3/17/25, the Medical Records Director initiated in-service training for nursing staff on the proper POLST process, including order updates. Medical Records will conduct daily audits, Monday through Friday, of the POLST Binder at each station to ensure the timely completion of any updated POLST orders. How the facility plans to monitor its performance to make sure that the solutions are sustained: Audit results will be reviewed at the monthly Quality Assurance Performance Improvement (QAPI) meeting. If 95% compliance is achieved after 90 days, the issue will be resolved within QAPI. Include dates when corrective action will be completed: Corrective action for deficient practice will be completed by March 18th, 2025.