Failure to Adhere to G-Tube Medication Flushing Protocols
Penalty
Summary
The facility failed to provide pharmaceutical services in accordance with physician orders and facility policy for three residents who required medication administration via gastrostomy tube (g-tube). For one resident with chronic respiratory failure, ventilator dependence, and dysphagia, the physician's order and care plan required flushing the g-tube with 20-50 ml of water before and after medication administration. However, a registered nurse administered only 10 ml of water after the last medication, contrary to the order. The nurse acknowledged that this amount might not be sufficient and could result in clogging the g-tube. The Director of Subacute confirmed that the facility's policy was to flush with 30-50 ml of water after medication administration to ensure hydration and complete delivery of medication. Another resident with chronic hypoxemic respiratory failure, tracheostomy, and pneumonia also had orders to flush the g-tube with 20-50 ml of water before and after medication administration. During observation, a licensed vocational nurse administered two medications sequentially without flushing the tube in between, as required by facility policy. The pharmacist noted that the medications given had a moderate risk of interaction, and the lack of flushing could contribute to this risk, although no immediate action was required for most residents. A third resident with chronic respiratory failure, ventilator dependence, and dysphagia was also observed to have medications administered via g-tube without flushing with water between medications. The nurse involved admitted to missing the flush, and the Director of Subacute reiterated that the facility's policy is to flush with water between medications to prevent drug interactions. Review of the facility's medication administration policy confirmed the requirement to flush the tube with a minimum of 50 ml of water and to rinse the medication cup to ensure complete dosing.