Failure to Follow Enteral Feeding Protocols and Physician Orders
Penalty
Summary
Two residents with feeding tubes experienced deficiencies in the provision of care according to professional standards. One resident, admitted with a history of stroke, diabetes, and malnutrition, was assessed as severely cognitively impaired and dependent on enteral feeding. Observations revealed that the resident's enteral feeding formula and water flush bags were not changed every 24 hours as required, with both bags labeled three days prior to the observation. Additionally, an open bottle of formula was found on the bedside table, undated and unrefrigerated, contrary to facility policy and staff statements that all open formula bottles should be dated and refrigerated after opening. Another resident, admitted with gastroparesis, severe malnutrition, and psychosis, was cognitively intact and also required a feeding tube. This resident's physician orders specified water flushes of 60 ml every four hours via both G and J tube ports. However, multiple observations showed that the water flushes were set at 50 ml every four hours, not in accordance with the prescribed orders. Staff interviews confirmed that the water flush setting was incorrect and should have matched the physician's order. Facility policy required that enteral feeding formula and water flush bags be changed every 24 hours and that open formula bottles be dated and refrigerated. The failure to follow these procedures for both residents was confirmed by nursing staff, the unit manager, the dietitian, and the DON, all of whom acknowledged the discrepancies between practice and policy or physician orders.