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F0658
D

Failure to Flush GTube Between Medications During Administration

Delano, California Survey Completed on 04-10-2025

Penalty

No penalty information released
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The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

Licensed Vocational Nurse (LVN) 2 failed to follow the facility's policy and procedure for medication administration through a feeding tube for one resident with a gastrostomy tube (GTube). During a medication pass, LVN 2 administered Docusate Sodium via the GTube and proceeded to administer the next medication without flushing the tube with water in between, as required by the facility's policy. The policy specifically states that when giving multiple medications, the tube should be flushed with 5-10 mL of water between medications. LVN 2 acknowledged during an interview that she did not flush the tube as required. The resident involved had orders for continuous tube feeding and was NPO (nothing by mouth) at the time of the incident.

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