Failure to Maintain Proper Head-of-Bed Elevation During Enteral Feeding
Penalty
Summary
The facility failed to ensure that a resident receiving enteral tube feeding was provided with appropriate care to prevent complications such as aspiration. Observations on two separate occasions showed that the resident was lying in bed with tube feeding infusing, but the head of the bed (HOB) was not elevated as required by both facility policy and CDC guidelines. The facility's policy and CDC guidance specify that the HOB should be elevated 30 to 45 degrees for residents receiving enteral feedings, unless medically contraindicated. The resident in question had diagnoses including cerebral palsy, epilepsy, and dysphagia, and was severely cognitively impaired according to the most recent assessment. Interviews with staff, including an LPN, the Infection Preventionist/Staff Development Coordinator, the DON, and the Administrator, confirmed that the expectation was for the HOB to be elevated for residents receiving tube feedings. The LPN stated that the resident experienced pain and yelled out when the HOB was elevated, so she raised it slowly throughout the shift. Despite these statements, observations confirmed that the HOB was not elevated during feedings, which was inconsistent with both policy and professional standards. The deficiency was identified for one resident with a feeding tube, and no evidence was provided that the required positioning was maintained during enteral feeding.