Failure to Follow Physician Orders for Enteral Feeding Downtime
Penalty
Summary
The facility failed to ensure that a resident receiving enteral nutrition via a gastrostomy tube was provided with appropriate treatment and services in accordance with physician orders. Specifically, nursing staff did not follow the prescribed feeding downtime for the resident, instead providing an additional two hours of downtime each day that was not ordered by the physician. This deviation from the physician's orders was not identified or corrected by the nursing staff, as the nurse responsible for the resident was unaware of the updated orders following the resident's readmission from the hospital. The nurse continued to follow the previous downtime schedule and did not review the current physician orders upon the resident's return. The resident in question was a male with a history of nontraumatic intracerebral hemorrhage, chronic respiratory failure with hypoxia, unspecified cirrhosis of the liver, and gastrostomy status. He was nonverbal and unable to answer questions. His care plan and physician orders specified continuous enteral feeding for 22 hours per day, with a scheduled downtime from midnight to 2 AM. However, observations and interviews revealed that the resident was routinely given an additional two-hour downtime from 10 AM to noon, resulting in a total of four hours of downtime daily. This practice was not in accordance with the current physician orders and was not communicated to or recognized by the interdisciplinary team. The discrepancy in feeding times coincided with a significant, unexplained weight loss for the resident, as documented by multiple weight checks. While staff and the dietitian questioned the accuracy of the scale and did not attribute the weight loss solely to the additional downtime, the failure to follow physician orders for enteral feeding was confirmed. The facility's policy required that enteral feedings be administered per physician order, but this was not adhered to in the resident's case. Interviews with nursing, dietary, and therapy staff further confirmed a lack of awareness and communication regarding the resident's current feeding schedule and physician orders.