Failure to Provide Ordered G-Tube Site Care
Penalty
Summary
The facility failed to provide appropriate gastrostomy (G-tube) site care for three residents on a specified date, as required by physician orders and facility policy. For each of the three residents, the Treatment Administration Record (TAR) indicated that the order to cleanse the G-tube site with normal saline, pat dry, apply a dry dressing, secure with tape daily, and assess for signs and symptoms of infection was not completed. This omission was confirmed through review of the TARs and interviews with nursing staff, who acknowledged that if the TAR was not signed, the treatment was not administered. The residents involved had significant medical conditions necessitating G-tube care. One resident had metabolic encephalopathy and was dependent on staff for oral hygiene, toileting, and showering, with intact cognition. The other two residents had hemiplegia and hemiparesis following cerebral infarction, severely impaired cognition, and were dependent on staff for all activities of daily living. All three residents had orders for daily G-tube site care, which were not carried out or documented on the specified date. Interviews with the treatment nurse and the Director of Nursing confirmed that the required treatments were not completed as ordered and that documentation was lacking. Facility policy required that the procedure be performed and documented to promote cleanliness and protect the gastrostomy site from irritation, breakdown, and infection. The job description for the treatment nurse also specified responsibility for administering treatments as ordered by the physician.