Failure to Administer Enteral Nutrition per Physician Order and Label Feeding Bottle Correctly
Penalty
Summary
The facility failed to provide enteral nutrition according to the physician's order for one resident receiving tube feeding. Observations on two consecutive days showed that the resident's enteral nutrition was being administered at 40 ml/hour, while the physician's order specified Jevity 1.5 at 45 ml/hour for 20 hours daily. Additionally, the nutrition bottle was not properly labeled with the resident's identifier and was incorrectly labeled with the flow rate. The resident's medical record indicated a history of severe protein-calorie malnutrition, failure to thrive, and feeding difficulties, and the resident was dependent on staff for eating and other activities of daily living. Interviews with staff revealed that CNAs did not adjust the feeding pump and that LPNs were responsible for confirming physician orders and monitoring tube placement. The Director of Nursing stated that facility policy required the resident's name, room number, time the bottle was hung, flow rate, and flush rate to be written on the enteral nutrition container. A review of the facility's policy confirmed that nurses are to administer enteral feedings as ordered by the physician and according to pump manufacturer guidelines. Despite these protocols, the observed discrepancies in administration rate and labeling constituted a failure to follow physician orders and facility policy for enteral nutrition.