Deficiencies in GT Medication Administration, Diet Orders, and Positioning
Penalty
Summary
The facility failed to ensure appropriate care and services for residents with gastrostomy tubes (GT), as evidenced by multiple deficiencies in medication administration, diet orders, and positioning during enteral feeding. For one resident with a GT and a diagnosis of dysphagia, the physician's orders for medication administration specified the oral route, despite the resident being unable to take anything by mouth. Licensed nurses administered and documented medications as given orally, even though the resident required all medications via GT. Staff interviews confirmed that the medication orders did not accurately reflect the resident's needs and that the route should have been updated to GT. Additionally, three residents with GTs did not have physician-ordered diets in their medical records. Staff, including LVNs, RNs, and the DON, acknowledged that all residents, including those with GTs, are required to have a diet order upon admission. The absence of a diet order was verified through medical record review and staff interviews, with staff stating that the expectation is to contact the physician to obtain the appropriate order or a swallow study if one is missing. Observations revealed that two residents receiving enteral feedings via GT were not positioned with the head of bed (HOB) elevated to at least 30 degrees, as required by physician orders and facility policy. Both residents were observed with the HOB elevated less than 30 degrees during feedings. Staff interviews confirmed that the HOB should have been elevated to prevent complications such as aspiration. The DON and other nursing leaders acknowledged these findings during interviews.