Failure to Administer and Document Enteral Feeding and Oral Care as Ordered
Penalty
Summary
A deficiency was identified when a resident with a history of dysphagia, hemiplegia, aphasia, and type 2 diabetes mellitus was not administered enteral feeding in accordance with the physician's order. The resident was prescribed a continuous tube feeding of Jevity 1.2 at 75 ml/hr for 20 hours per day, totaling 1500 ml, and was also ordered to receive oral care every shift. Observations revealed that the feeding tube was disconnected, and the amount of feeding solution administered was insufficient compared to the prescribed amount. Staff interviews confirmed that the feeding was stopped prematurely and that there was no documentation of the specific amount of enteral feeding given. Further observations showed that the resident had whitish buildup and tartar in the mouth, indicating that oral care had not been performed as ordered. The CNA responsible for the resident stated that oral care had not yet been provided that morning, and there was no toothbrush available at the bedside. Instead, lemon glycerin swab sticks and foam-tipped swab sticks were used for oral care, but these were not utilized during the observed period. Record reviews and staff interviews confirmed that there was no hourly, per shift, or daily documentation and monitoring of the resident's enteral feeding intake. The DON, RN, and dietician all verified the lack of accurate monitoring and documentation, and acknowledged that the resident did not receive the prescribed amount of enteral feeding. Facility policy required documentation of the amount and type of enteral feeding, as well as monitoring for adequate nutrition, but these procedures were not followed.