Failure to Document and Adhere to Tube Feeding Protocols
Penalty
Summary
Facility staff failed to provide appropriate care and documentation for a resident receiving enteral tube feeding, resulting in a deficiency related to the prevention of possible complications such as diarrhea, vomiting, and dehydration. Observations revealed that the tube feeding was hung and spiked at the bedside, with the tubing primed, but the time the tube feeding was hung was not documented on the label as required. The facility's policy and manufacturer guidelines indicated that tube feeding formula should not hang for more than 24 hours after being spiked, and that the system should be changed accordingly to prevent contamination. The resident involved had diagnoses including diabetes mellitus type 2, cachexia, and depression, and was assessed to have moderate cognitive impairment. Physician's orders specified that enteral nutrition was to be administered via pump for 10 hours nightly. Despite these orders, staff interviews revealed inconsistent practices and understanding regarding when tube feeding should be hung, how long it could remain in place, and the importance of documenting the hang time. Some staff indicated that tube feeding could be hung for up to 48 hours, while others stated it should be discarded after 24 hours, and several staff members acknowledged that hanging the feeding early or failing to document the time could lead to contamination or spoilage. Multiple staff interviews confirmed that the tube feeding was sometimes hung or spiked before the scheduled start time, and that documentation of the hang time was not consistently performed. The lack of proper documentation and adherence to established guidelines increased the risk of bacterial contamination and compromised the safety of the enteral feeding process for the resident. The deficiency was identified through observation, record review, and staff interviews, all of which highlighted lapses in following both facility policy and manufacturer recommendations for tube feeding care.