Failure to Maintain Proper Head of Bed Elevation During Enteral Feeding
Penalty
Summary
A deficiency was identified when a resident receiving continuous enteral feeding was not maintained with the head of bed (HOB) elevated as required by physician orders and the resident's care plan. The resident, a female with multiple diagnoses including seizures, poor coordination, aphasia, anxiety, psychosis, and schizoaffective disorder, was observed in bed with the HOB at 30 degrees, but her torso and upper body were lying flat halfway down the mattress while tube feeding was ongoing. Staff interviews revealed inconsistent understanding and implementation of the required HOB elevation, with some staff believing a lower elevation was sufficient and others acknowledging the need for a 45-degree angle. The resident was nonverbal and unable to self-advocate for proper positioning. Record reviews showed that both the care plan and physician orders specified maintaining the HOB at a minimum of 30 degrees, preferably 45 degrees, during and after tube feeding to reduce aspiration risk. However, staff interviews indicated a lack of recent training on G-tube monitoring and positioning, and the facility's policy did not directly address required bed elevation during enteral feeding. The resident's tendency to slide down in bed was noted, but regular repositioning to maintain proper alignment was not consistently performed, leading to the deficiency.