Failure to Follow Physician Orders and Professional Standards for PEG Tube Medication Administration
Penalty
Summary
The facility failed to follow physician orders and professional standards for administering medications and water through a PEG tube for one resident. During medication administration, an LPN was observed preparing and administering multiple medications without measuring the required amount of water, using only ten milliliters instead of the physician-ordered fifteen milliliters between each medication. The LPN also failed to flush the PEG tube before medication administration, resulting in a clogged tube. To address the clog, the LPN used tubing from the resident's nightstand without cleaning it, then returned the uncleaned tubing to the nightstand after use. The LPN was unable to specify the amount of water used for flushing and did not provide water flushes after medication administration as required by the physician's orders. Additionally, the LPN did not check the PEG tube for placement or residual prior to administering medications and could not provide documentation of these checks. The LPN also omitted a prescribed multivitamin because it was not available in the medication cart and did not verify its availability in the medication room at the time of administration. The physician's orders required flushing the PEG tube with at least fifteen milliliters of water before and after medication administration and between each medication, as well as checking for tube placement and residual. The facility's policy also required medication administration in accordance with written physician orders. The DON confirmed that the nurse should have checked tube placement and cleaned the tubing before use to prevent infection.