Failure to Elevate Head of Bed and Manage Secretions During Enteral Medication Administration
Penalty
Summary
A deficiency occurred when a resident with a gastrostomy tube and multiple complex medical conditions, including pneumonia, chronic respiratory failure, anoxic brain damage, and a tracheostomy, was observed lying flat in bed with the feeding tube connected to an enteral feeding pump that was turned off. The resident had large oral secretions draining from both sides of the mouth and onto the neck, and whitish secretions were visible. The resident's care plan and physician orders required the head of the bed to be elevated, especially during and after medication administration via the gastrostomy tube, to prevent complications such as aspiration. However, after medication was administered through the gastrostomy tube, the nurse failed to elevate the head of the bed and did not assess the resident's respiratory status or clean the oral secretions. The Director of Nursing acknowledged that the bed should have been elevated, but later stated it was not necessary since the feeding tube was off, despite facility policy requiring the head of the bed to be elevated to 30-45 degrees for at least 30 minutes after medication administration. The facility's own policies on gastrostomy tube care and enteral medication administration were not followed, as the resident remained flat for nearly an hour after medication was given, and oral secretions were not promptly managed. These actions and inactions led to a failure to provide appropriate care and services to prevent possible complications for the resident receiving enteral nutrition and medications.