Failure to Verify G-Tube Placement Prior to Feedings
Penalty
Summary
The facility failed to follow professional standards of care for a resident with a gastrostomy tube by not verifying tube placement prior to administering enteral feedings. Observations showed that an LPN did not disinfect the G-tube ports or the tip of the tube feeding, nor did she check for G-tube placement or assess bowel sounds before administering the feeding. The LPN stated that she only checks tube placement in the morning and not before each feeding, which is inconsistent with both facility policy and professional guidelines. Additionally, she did not document G-tube placement checks or residuals in the progress notes, and there was no section in the Medication Administration Record (MAR) for such documentation. The resident involved had significant medical conditions, including tracheostomy status, dysphagia, gastrostomy status, GERD, respiratory disorders, and anoxic brain damage, and was dependent on tube feedings. The care plan identified a risk for aspiration and required verification of tube placement and assessment of bowel sounds before each feeding and medication administration. Interviews with the ADON confirmed that standard practice is to check for residual volume and tube placement before feedings and medications, but there was uncertainty about whether this was consistently done by nursing staff, and these checks were not included in physician orders.