Improper Enteral Medication Administration and Inadequate Tube Flushing
Penalty
Summary
A deficiency was identified when a licensed vocational nurse (LVN) failed to follow proper technique during medication administration through an enteral tube for a resident with severe cognitive impairment and total dependence on staff for activities of daily living. The LVN crushed magnesium oxide and zinc tablets, placed them in separate medication cups with water, and administered them via the resident's enteral tube. After administration, excess crushed medication remained in both cups, indicating the resident did not receive the full prescribed dose. Additionally, the LVN flushed the enteral tube with only 10 milliliters of water between medications, despite a physician's order specifying a 15 milliliter flush between each medication. The resident's medical records confirmed the presence of an enteral tube and orders for medication administration, including the required flush volume. Both the LVN and the Director of Nursing acknowledged during interviews that the full dose of medication should be administered and the tube should be flushed with the ordered amount of water to ensure proper delivery and prevent tube clogging. Facility policies also required adherence to prescriber orders for medication administration and flushing volumes.