Failure to Follow Enteral Feeding Tube Protocols and Medication Order Clarification
Penalty
Summary
The facility failed to provide appropriate care for two residents with enteral feeding tubes by not adhering to manufacturer and facility protocols regarding the timely replacement of water flush bags. For both residents, observations revealed that the water flush bags used for tube feeding were not changed within the recommended 24-hour period. Specifically, one resident's water flush bag was dated four days prior to the observation, and the other resident's bag was dated five days prior. The Director of Nursing confirmed that the water flush bags should be changed every 24 hours, as per facility policy and manufacturer guidelines. Additionally, there was a failure to clarify a physician's order regarding medication administration for one resident who was documented as NPO (nothing by mouth) but was receiving medications via a gastrostomy tube. The physician's order specified that the medication was to be given orally, yet the medication was administered through the G-tube without clarification from the physician. The DON acknowledged that the route of administration should have been verified and clarified with the physician to ensure safe medication administration. Both residents involved had significant medical histories, including conditions such as encephalopathy, protein-calorie malnutrition, dysphagia, dementia, hemiplegia, and respiratory failure. At the time of the deficiencies, one resident was dependent on staff for all activities of daily living and lacked decision-making capacity, while the other had severely impaired cognition. The facility's own policies and the manufacturer's instructions were not followed in these instances, leading to the identified deficiencies.