Improper Administration of Benzonatate via G-Tube
Penalty
Summary
Facility staff failed to ensure that medications were administered in accordance with professional standards of practice for a resident with a gastrostomy tube (G-tube). The resident, who had multiple diagnoses including dysphagia, aphasia, and a history of cerebral infarction, was non-verbal and dependent on staff for activities of daily living. The resident had physician orders for benzonatate capsules to be administered via G-tube as needed for cough, despite the medication's package insert stating that capsules should be swallowed whole and not broken, chewed, dissolved, cut, or crushed due to the risk of local anesthesia and choking if the contents are released in the mouth. Observations and interviews revealed that staff, following instructions from the facility's pharmacy, punctured the benzonatate capsules, extracted the liquid, and administered it via the G-tube, followed by a water flush. The pharmacist acknowledged that there were no specific references or literature supporting this method but stated it had been used based on experience and physician orders. The Director of Nursing later confirmed that a liquid formulation should have been selected for G-tube administration and expressed concerns about the safety and efficacy of aspirating the capsule contents for dosing. Facility policy required staff to check medication labels, drug handbooks, or consult the pharmacy to determine if a medication was on the 'do not crush' list before administering through an enteral tube. The policy also specified that liquid forms should be requested when possible and that the contents of capsules should not be crushed or administered through an enteral tube unless verified as safe. Despite these policies, benzonatate capsules were administered via G-tube in a manner inconsistent with professional standards and manufacturer instructions.