Failure to Maintain Proper Bed Elevation During Enteral Feeding
Penalty
Summary
A dependent resident receiving enteral tube feeding was found lying in bed with the head of the bed elevated only to a 20-degree angle while the feeding was infusing. Observation confirmed that the resident was positioned low in the bed, with feet touching the footboard, and the head of the bed was not elevated to the required angle. A CNA acknowledged that the resident should have been positioned with the head of the bed at a 40-degree angle to prevent choking and that it was her responsibility to monitor the resident when the hospice CNA was not present. The CNA then repositioned the resident and adjusted the bed elevation accordingly. The Director of Nursing confirmed that all residents with feeding tubes should have the head of the bed elevated at a 30-40-degree angle and be properly positioned in bed to prevent aspiration. The resident's medical record indicated diagnoses of unspecified protein calorie malnutrition, gastrostomy status, chronic kidney disease, and muscle wasting, with a physician order specifying that the head of the bed should always be elevated at a 45-degree angle during tube feeding, except during activities of daily living. Facility policy also required nurses to maintain the head of the bed at 30-45 degrees during and after tube feeding. These requirements were not followed at the time of observation.