Failure to Follow Physician Orders for Enteral Feeding Administration
Penalty
Summary
The facility failed to ensure that a resident receiving enteral nutrition via a gastrostomy tube was administered the prescribed amount of high-protein tube-feeding formula as ordered by the physician. The physician's order specified that the resident should receive 55ml per hour of a 1.5 calorie formula continuously for 22 hours each day. However, observation and record review revealed that the feeding machine was set to deliver 56ml per hour instead of the ordered 55ml per hour. The resident in question had significant medical conditions, including acute and chronic respiratory failure, moderate protein-calorie malnutrition, and dehydration, and was dependent on tube feeding for more than half of his caloric intake. The care plan for the resident emphasized the importance of following physician orders for tube feedings to prevent complications such as aspiration, dehydration, and nutritional compromise. Despite this, the medication administration record and direct observation confirmed that the feeding was not administered as ordered. Interviews with facility staff, including the DON, Administrator, and the responsible RN, confirmed that the deviation from the physician's order was not intentional and may have resulted from CNAs stopping and starting the feeding machine during care, potentially altering the settings. The RN acknowledged responsibility for verifying the correct administration rate and was unaware of the discrepancy until it was brought to his attention. Facility policy required staff to review and implement physician orders accurately and document any clarifications, but this was not followed in this instance.