Failure to Ensure Accurate Feeding Tube Orders and Adequate Hydration
Penalty
Summary
The facility failed to ensure that residents with feeding tubes received appropriate treatment and services, as evidenced by incomplete and inaccurate physician orders and failure to follow registered dietitian (RD) recommendations. For one resident with a PEG tube who was severely cognitively impaired and at risk for aspiration, physician orders were not updated to reflect the correct route of medication administration. Despite the resident being designated as NPO (nothing by mouth), some medications were still ordered to be given orally, and staff administered medications via the PEG tube without clear, accurate orders specifying this route. The director of nursing acknowledged that the orders were not accurate and that it was the responsibility of the nurse entering the orders to ensure their completeness and correctness. Another resident with a feeding tube, who was alert and oriented, experienced inadequate hydration due to the facility's failure to update physician orders in accordance with the RD's recommendations. The RD had assessed that the resident's fluid needs were not being met and recommended an increase in water flushes before and after feedings. However, the physician's orders were not updated to reflect this recommendation, and the medication administration record did not document that the additional hydration was provided. Additionally, a nurse administered an unmeasured amount of water during medication administration, and the electronic medical record lacked specific instructions for water flush amounts during this process. These deficiencies were identified through observations, record reviews, and staff and resident interviews, which revealed that the facility did not ensure physician orders were complete, accurate, and followed, nor did it ensure that residents received adequate hydration as recommended by the RD. The failures involved both the accuracy of medication administration routes and the provision of sufficient hydration for residents with feeding tubes.