Failure to Verify G-Tube Placement, Check Residuals, and Document Care During Tube Feedings
Penalty
Summary
The facility failed to ensure proper care and documentation for residents with gastrostomy tubes (G-tubes) during tube feeding administration. In one instance, an LPN administered a bolus G-tube feeding to a resident without checking tube placement or residual immediately prior to the feeding, as required by physician orders and care plan interventions. Additionally, the LPN did not flush the G-tube with water after the feeding was completed, contrary to the physician's order for scheduled flushes. The resident's diagnoses included gastrostomy status, dysphagia, and protein calorie malnutrition, and the care plan specified the need to check tube placement and residual volume per protocol and record the findings. For another resident, the facility failed to document the amount of G-tube residual on multiple dates, despite a physician's order to check and record residual every shift. The resident's care plan also required checking tube placement and residual volume per protocol. The medication administration record (MAR) for the relevant month did not include a place to document residuals, and the DON confirmed the omission during an interview. A third resident received a bolus tube feeding without verification of tube placement or checking for residual prior to administration. The nurse administering the feeding acknowledged not performing these checks, despite the facility's policy requiring verification of placement and residual. The resident's care plan and physician orders included instructions for enteral nutrition and specified the need to check tube placement and residual volume per protocol. The facility's policy on tube feeding also required checking tube placement and flushing the tube with water at the end of the feeding.