Failure to Return Gastric Residual During PEG Tube Care
Penalty
Summary
A deficiency occurred when a resident with a Percutaneous Endoscopic Gastrostomy (PEG) tube did not receive appropriate care during a medication pass. An LPN checked the placement of the resident's feeding tube and withdrew three and one-half 60 ml syringes of beige-colored gastric residual, totaling 150 cc. Instead of returning the gastric residual to the resident, as required by standard nursing practice and facility policy, the LPN discarded the contents by flushing them down the toilet. The LPN acknowledged that this action resulted in a lost feeding for the resident, which could lead to fluid and nutrient imbalance and possible weight loss. The Director of Nursing confirmed that the gastric residual should have been returned to the resident and that failure to do so could result in weight loss or electrolyte imbalance. The resident involved was admitted with diagnoses including cerebral infarction, dysphagia, and required attention to a gastrostomy. The resident was cognitively intact at the time of the incident, as indicated by a BIMS score of 13. The facility's policy states that residents unable or unwilling to ingest oral nutrients should be properly provided nutrition and care, which was not followed in this instance.