Failure to Assess and Care Plan for Self-Administration of Enteral Feeding
Penalty
Summary
A deficiency occurred when the facility failed to ensure that a resident receiving enteral feeding was properly assessed and care planned for self-administration of gastrostomy tube (g-tube) bolus feedings. The resident, who was cognitively intact and her own responsible party, had a complex medical history including progressive systemic sclerosis, dysphagia, severe protein calorie malnutrition, and gastroparesis. Despite her ability to communicate and understand care instructions, there was no documented assessment or care plan addressing her self-administration of g-tube feedings upon both her initial and subsequent admissions. Observations and interviews revealed that the resident had been self-administering her g-tube feedings three times daily since admission, with minimal supervision from nursing staff. The resident reported being trained by previous nurses and expressed comfort with the procedure, but also stated she was fatigued from performing all feedings herself and had requested more assistance from staff. Nursing staff confirmed that while they had supervised her feedings in the past, there was no formal assessment or care plan in place for her self-administration, and responsibilities for monitoring and documentation were unclear among staff members. The facility's policy required periodic reassessment and documentation of the appropriateness and necessity of enteral nutrition, including input from the resident. However, the care plan and physician orders did not reflect the resident's self-administration of feeds, nor was there evidence of an initial or ongoing assessment for this practice. This lack of assessment and care planning could result in the resident's needs not being met and a decline in her health, as noted in the findings.