Failure to Provide Physician-Ordered Enteral Feeding and G-Tube Care
Penalty
Summary
The facility failed to ensure that a resident with a gastrostomy tube (G-tube) received appropriate care and services as required for enteral feedings and G-tube site management. Specifically, there were no physician's orders in place for essential aspects of enteral feeding care, including G-tube site care, monitoring and recording of gastric residuals, and clear instructions for medication administration via the G-tube for a resident who was ordered nothing by mouth (NPO). The resident's care plans referenced interventions such as checking tube placement, monitoring residuals, and providing G-tube site care, but these were not supported by corresponding physician's orders or documentation in the clinical record. Record reviews revealed that scheduled G-tube feedings and water boluses were not administered on several occasions because the resident was asleep, contrary to the expectation that feedings should be given as ordered regardless of the resident's sleep status. Additionally, the medication administration records did not show evidence of G-tube site care, documentation of residual checks, or mouth care being provided. Medications were ordered and documented as being given by mouth, despite the resident's NPO status and the need for medications to be administered via the G-tube. Interviews with nursing staff confirmed the lack of necessary physician's orders for G-tube site care, residual checks, and medication administration via the correct route. Observations also found that equipment, such as the piston syringe used for feedings, was not changed daily as required. The resident involved had severe cognitive impairment, was dependent on tube feedings, and was at risk for skin impairment, yet the facility did not have adequate orders or documentation to ensure safe and appropriate care for the resident's enteral feeding needs.