Failure to Label and Administer Enteral Feedings per Physician Orders
Penalty
Summary
Nursing staff failed to adhere to professional standards of practice for the administration of free water flushes and enteral tube feeding for six out of seven residents observed with tube feeds. Specifically, staff did not consistently label and date enteral free water administration bags and tube feeding bottles, as required for safe administration and monitoring. In several cases, the amount of tube feeding administered did not match the physician's orders, indicating a lack of compliance with prescribed nutritional regimens. For example, one resident with protein-calorie malnutrition, ventilator dependence, and muscle wasting had a water bag for free water flushes that was not labeled with the date hung. Another resident, also with protein-calorie malnutrition and ventilator dependence, had both an unlabeled water administration bag and discrepancies between the amount of tube feeding administered and the physician's order. Additional residents with diagnoses such as dysphagia, Alzheimer's disease, Guillain-Barre Syndrome, and amyotrophic lateral sclerosis were observed with either unlabeled tube feeding bottles, unlabeled free water administration bags, or both. In multiple instances, the volume of tube feeding delivered did not correspond to the prescribed rate and duration, as evidenced by the remaining volume in the bottles and the time elapsed since they were hung. The facility's policies on enteral nutrition and safety precautions did not specify requirements for labeling and dating tube feeding and free water administration bags, contributing to inconsistent practices among staff. During interviews, the DON confirmed that all enteral free water administration bags and tube feeding bottles should be labeled with the date, time hung, and prescribed rate of flow, and that nurses are responsible for ensuring the correct amount is administered as ordered. The observed deficiencies were based on direct observations, record reviews, and staff interviews.