Failure to Follow Physician Orders and Document Enteral Nutrition Administration
Penalty
Summary
The facility failed to ensure that physician orders for enteral nutrition were followed and that appropriate documentation and care were provided for a resident receiving tube feedings. Observations over several days revealed that the resident's enteral nutrition was frequently turned off outside of the physician-ordered two-hour break, and feeding equipment, such as syringes, was not changed daily as required. The feeding formula and equipment were observed to be dated from previous days, and the feeding tube was found uncapped and wrapped around the pole when not in use. The resident in question had diagnoses including pneumonitis due to inhalation of food and vomit, dysphagia, and dementia, and was dependent on staff for transfers. The care plan required monitoring of caloric intake, and physician orders specified a continuous enteral feeding regimen with specific amounts and times, as well as regular flushing and equipment changes. However, the Medication Administration Record (MAR) showed inconsistent documentation of the amounts of formula administered, with several days lacking complete records or showing significant deviations from the ordered volume. There was also a lack of documentation regarding when the enteral nutrition was turned off or when the resident refused nutrition, except for two documented refusals with physician notification. Facility policies required close monitoring of tube feeding tolerance, intake and output, and prompt documentation of changes in the resident's condition, including refusals and notifications to the physician. Despite these policies, the clinical record did not consistently reflect refusals, changes in feeding administration, or timely notifications to the physician when the resident did not receive the prescribed amount of nutrition. Interviews with the DON and Regional Nurse confirmed that documentation and adherence to physician orders were expected but not consistently followed in this case.