Deficiencies in Feeding Tube Management and Medication Administration
Penalty
Summary
The facility failed to provide appropriate treatment and services to prevent complications of feeding for a resident who was admitted with several medical conditions, including a severe mental status. The resident had specific physician orders for feeding tube management, which included checking tube placement before feeding or medication administration, and ensuring the tube's patency. However, during an observation, a Licensed Practical Nurse (LPN) connected the feeding tube without verifying its placement or patency, contrary to the facility's policy and the resident's care plan. Additionally, the facility did not ensure that all nursing staff met professional standards of quality and competency. During a medication administration observation, a Registered Nurse (RN) was found to have crushed medications and stored them in a medication cart drawer without having the necessary equipment, such as a laptop, to verify the medication administration record (MAR) at the time. The RN admitted to relying on her memory and previous access to the MAR on another computer, which was not in line with the facility's standards for medication administration. The Director of Nursing (DON) and the Administrator acknowledged the deficiencies, noting that the RN was new to the facility and had not completed the required orientation checklist for professional staff. The Administrator expressed concern over the RN's preparedness and the inconsistency in the orientation process, which was previously managed by an Assistant Director of Nursing who had been terminated for inconsistent work performance.
Plan Of Correction
The statement made on this Plan of Correction are not and do not constitute an agreement with the alleged deficiencies herein. To remain in compliance with all federal and state regulation, the center has taken or will take the actions set forth in the following plan of correction. The following plan of correction constitutes the center's allegation of compliance such that all alleged deficiencies cited have been or will be corrected by the date indicated. Immediate Corrective Action: Resident #43 was assessed by the Director of Nursing for signs of feeding intolerance, placement, and residual. Resident #43 was tolerating feeding okay, placement was confirmed with no residual. On re-education on feeding administration was immediately provided to staff A, the licensed Practical Nurse. Identification of other residents potentially affected: Current residents have the potential to be affected; however, based on the residents' assessment and observation completed, no resident was affected. Measures: Staff A was provided with competency skills training on Feeding Administration by the Director of Nursing. a. Verifying the five rights of administration b. Safety & Proper Positioning c. Tube Placement d. Residual e. Flush f. Control On Relias training was completed by staff A on feeding. Inservice/training will be completed for newly hired licensed nurses. Monitoring: The Director of Nursing/nursing team will complete daily audits for 4 weeks and then weekly for 2 months to ensure licensed nurses follow the policy and procedure and provide appropriate treatment and services to prevent complications of feeding. The Director of Nursing will report the findings to the Quality Assurance Performance Improvement Committee Monthly for 3 months or until the committee determines substantial compliance.