Failure to Implement Care Plan for Enteral Nutrition Positioning
Penalty
Summary
The facility failed to implement care plan interventions for a resident requiring enteral nutrition via tube feeding. The resident's care plan specified that the head of bed (HOB) should be elevated to 45 degrees during and for thirty minutes after tube feeding to prevent complications. However, multiple observations showed the resident receiving tube feedings with the HOB elevated less than 45 degrees, sometimes as low as approximately 30 degrees. These observations occurred while the enteral nutrition pump was administering the feeding. Review of the resident's medical record indicated diagnoses including protein calorie malnutrition, dysphagia, aphasia, cognitive communication deficit, and gastrostomy status, with a moderately impaired cognitive status. Staff interviews revealed inconsistent understanding of the required HOB elevation, with some staff stating the range should be 30 to 45 degrees, and others unable to specify the policy. The facility's policy required the HOB to be positioned at 30 to 45 degrees unless contraindicated, but the care plan specifically called for 45 degrees. There were no physician orders specifying the degree of elevation, and staff confirmed the care plan intervention was not consistently implemented.