Failure to Follow G-Tube Protocols and Physician Orders
Penalty
Summary
A deficiency was identified when staff failed to follow physician's orders regarding the care of a resident with a gastrostomy tube (G-tube). Specifically, during a medication administration observation, a charge nurse (LPN) did not check for gastric residuals or verify proper G-tube placement before administering scheduled medications and flushes, as required by both the physician's orders and the facility's policy. The resident involved had severe cognitive impairment and multiple diagnoses, including gastrostomy status, acute respiratory failure, seizures, and encephalopathy. The care plan and physician orders clearly specified the need to check tube placement and gastric residuals prior to feeding, flushing, or medication administration. Interviews with staff revealed inconsistent adherence to these protocols, with one LPN admitting to only sometimes checking for residuals and placement, and confirming that these checks were not performed during the observed incident. Review of training records showed that tube feeding was not directly addressed in the medication administration skills checklist, and computer-based education did not include tube feeding training. Although inservices and skill checkoffs were conducted, the observed failure to follow established procedures led to the deficiency.