Failure to Follow Physician Orders for G-Tube Care and Administration
Penalty
Summary
Staff failed to follow physician's orders regarding the care and use of a gastrostomy tube (g-tube) for a resident with multiple diagnoses, including gastrostomy status, type 2 diabetes mellitus with chronic kidney disease, and diverticulosis. The physician's order specified that the g-tube should be flushed with 30 ml of water three times daily. However, documentation showed that a nurse administered 120 ml of Med Pass 2.0 nutrition and 240 ml of water through the g-tube, despite no physician's order specifying the administration of Med Pass or hydration via the g-tube. Additionally, the order for Med Pass did not indicate the route of administration, and there was no order for the 240 ml water flush through the g-tube. Interviews with staff confirmed that the only authorized use of the g-tube was for 30 ml water flushes per shift, as per the physician's order. Facility policy required that the route of administration for any medication or supplement via feeding tube be clearly specified in the physician's order and documented in the medication administration record. The lack of clear orders and documentation, as well as the administration of fluids and supplements through the g-tube without proper authorization, led to the deficiency.