Failure to Administer Physician-Ordered Hydration for Tube Feeding
Penalty
Summary
The facility failed to follow and administer physician-ordered hydration for a resident with a feeding tube. The resident, who had diagnoses including functional quadriplegia, adult failure to thrive, and protein-calorie malnutrition, was assessed as having moderate cognitive impairment and required tube feeding for nutritional support. Physician orders specified that the feeding tube should be flushed with 120 mL of water before and after each Jevity feeding, totaling 240 mL per feeding. However, review of the Medication Administration Record (MAR) for the month showed that the water flushes provided were inconsistent with the physician's orders, with amounts both below and above the prescribed volume, and the daily totals were incorrect. The resident's care plan indicated the need for tube feeding and specified interventions such as providing 120 mL of water before and after each feeding and monitoring for dehydration. During an interview, an LPN confirmed that the resident should have received the specified water flushes and that the amounts were documented in the MAR. Despite this, the MAR lacked documentation of the correct amount of water flushes and accurate daily totals. The facility's policy required adherence to clinical standards and physician orders for feeding tube care, including hydration, but these were not followed as documented.