Failure to Ensure Physician Order and Assessment for Self-Administration of G-Tube Feeding
Penalty
Summary
Facility staff failed to ensure that a resident who was self-administering a medical nutritional supplement via gastrostomy tube (g-tube) had a physician's order authorizing self-administration. The resident, who had a history of malignant neoplasms of the larynx and esophagus, gastrostomy status, pneumonitis due to inhalation of food and vomit, lack of coordination, and chronic respiratory failure, was observed with an open water pitcher containing a brown/tan liquid and a piston syringe at the bedside. The resident identified the liquid as Jevity, a tube feeding formula, and stated they self-administered the feeding. Nursing staff were unaware of the contents of the pitcher and could not confirm the presence of a physician's order for self-administration. Further review of the resident's records showed an order for Jevity bolus feedings but no specific order permitting the resident to self-administer the feeding. Additionally, there was no documented assessment or education to determine the resident's cognitive and physical ability to safely self-administer the g-tube feeding, as required by facility policy. The facility's policy mandates that residents must be assessed for mental and physical capability and have physician approval before being allowed to self-administer medications or nutritional supplements.