Failure to Verify G-Tube Placement Prior to Water Flush and Medication Administration
Penalty
Summary
A deficiency occurred when a licensed vocational nurse (LVN) failed to follow physician orders and facility policy regarding the care of a resident with a gastrostomy tube (g-tube). The resident, who had diagnoses of dysphagia and pneumonia and was assessed as severely cognitively impaired and fully dependent for activities of daily living, had orders requiring that g-tube placement be checked prior to administering formula, medications, or water flushes. The care plan and facility policy also specified that tube placement and gastric residuals should be checked before any administration through the tube. During a medication pass, the LVN was observed pausing the resident's feeding and administering a 50 ml water flush through the g-tube without first verifying tube placement as required. Only after the flush was given did the LVN attempt to check tube placement by pushing air through the tube and listening for a sound in the abdomen. The LVN acknowledged not checking placement prior to the flush and was under the impression that either checking for residual or listening for a sound after air injection was sufficient. Interviews with the Director of Nursing (DON) and review of facility policies confirmed that tube placement should be verified before any flush or medication administration, and that checking residuals is also necessary to assess feeding tolerance. The facility's written procedures emphasized the importance of these steps to ensure safe administration and prevent complications. The failure to follow these protocols constituted a deficiency in providing appropriate care for a resident with a feeding tube.