Failure to Care Plan for Self-Administration of G-Tube Feedings
Penalty
Summary
The facility failed to develop and implement a person-centered care plan that addressed all of a resident's needs, specifically omitting the assessment and care planning for self-administration of gastrostomy tube (g-tube) feedings. The resident, a cognitively intact female with multiple complex diagnoses including progressive systemic sclerosis, dysphagia, and severe malnutrition, had been self-administering her g-tube bolus feedings three times daily since admission. Despite this, her care plan did not reflect an assessment or interventions for self-administration of enteral feedings, nor did it include measurable objectives or timeframes related to this aspect of her care. Observations and interviews revealed that the resident was comfortable performing her own g-tube feedings but expressed fatigue and a desire for more assistance from staff. Nursing staff confirmed that the resident had been trained to self-administer her feedings and that supervision was provided inconsistently. However, there was no documented assessment of her ability to self-administer, and the care plan did not address this practice. Staff interviews indicated a lack of clarity regarding responsibility for care planning and assessment of self-administration, with some staff believing the resident was care planned for this and others stating it was not within their scope to complete such care plans. The facility's policy required the interdisciplinary team to develop and update comprehensive, person-centered care plans in response to changes in a resident's condition or care needs. Despite this, the care plan for this resident did not reflect her actual practice of self-administering g-tube feedings, nor did it include the necessary assessments or interventions to ensure her needs were met. This omission was identified through record review, staff and resident interviews, and observation, demonstrating a failure to provide a complete and individualized care plan as required.