Failure to Check Tube Feeding Residuals as Ordered
Penalty
Summary
A deficiency was identified when a nurse failed to check for gastric residuals prior to administering a tube feeding to a resident with a gastro/jejunal feeding tube, as required by physician orders and facility policy. Observation showed that the LPN administered the feeding without verifying residuals, and the nurse later confirmed that this step was not always performed before feedings. The resident's care plan and physician orders specifically required checking tube placement and residual volume before each feeding and medication administration, with instructions to hold feedings if residuals exceeded a certain amount. The resident involved had diagnoses including tracheostomy, neoplasm of the larynx, and dysphagia, and was cognitively intact, requiring supervision for certain activities. Review of the clinical record and interviews with staff and a family member confirmed that the practice of checking residuals was not consistently followed. The Director of Nursing also acknowledged that staff were expected to check residuals prior to each feeding, in accordance with facility policy and physician orders.