Failure to Ensure Agency Nurse Competency in J-Tube Care
Penalty
Summary
The facility failed to ensure that agency nurses were properly trained and competent to care for residents with jejunostomy tubes (j-tubes). An agency LPN, who was hired without documented competency or specific training on j-tubes, was involved in an incident where a resident's j-tube became dislodged. The nurse did not recognize the need for hospital treatment and instead inserted a urinary catheter tube into the j-tube site, mistakenly assuming it was a gastrostomy tube. This action was performed without a physician's order and without the necessary radiographic or surgical guidance required for j-tube replacement. Record review confirmed that the nurse's employee file lacked evidence of j-tube competency or training, and the facility's orientation for agency nurses did not include specific instruction on j-tubes at the time of her employment. Interviews with the nurse revealed she did not recall receiving j-tube training during orientation at this facility, despite having prior experience elsewhere. The DON stated that the agency was responsible for verifying nurse competencies, and acknowledged that the facility's orientation did not cover j-tube care for agency nurses. The incident was identified during a review of three nurses for competency and three residents with feeding tubes. The nurse's improper handling of the dislodged j-tube created a high likelihood of serious harm, as confirmed by interviews with the nurse practitioner, medical director, staff, and the responsible party. The deficiency was limited to one resident with a j-tube, and no other residents with j-tubes were identified in the facility during the review period.
Removal Plan
- The Director of Nursing (DON), Assistant Director of Nursing (ADON), and Unit Managers will provide education to Licensed Nurses on Gastrostomy Tube Reinsertion Policy, including what to do if a j-tube becomes dislodged, physician notification, not to attempt reinsertion of the j-tube, risks, and sending the resident to the hospital for surgical reinsertion.
- A quiz was created to validate staff understanding of the material that was taught. Any nurse that cannot answer the quiz questions appropriately will be retrained by the DON or ADON on the material.
- The Director of Nursing will track and verify that employees with scheduled time off, on leave of absence (FMLA), vacation, agency staff or PRN staff will be re-educated prior to returning to duty.
- New hires and Agency Nurses will be educated by the DON or ADON during the orientation process using the Gastrostomy Tube Reinsertion Policy.
- The quiz will be given at the end of their training to validate understanding on what to do if a j-tube becomes dislodged, including physician notification, not to attempt reinsertion of the j-tube, risks, and sending the resident to the hospital for surgical reinsertion.