Failure to Follow and Document Enteral Feeding Orders
Penalty
Summary
The facility failed to ensure that enteral feeding orders for a resident with a gastrostomy tube were followed as prescribed, and that the total volume delivered was consistently monitored and documented. The resident, who was entirely dependent on tube feeding due to dysphagia and had diagnoses including risk for malnutrition, diabetes mellitus, and dementia, had a physician order for Nepro 1.8 at 35 mL/hour for 15 hours daily, totaling 525 mL per day. Observations revealed that the tube feeding was not always flowing as ordered, and the total volume delivered over a 30-day period was 1,927 mL less than prescribed. The Medication Administration Record (MAR) lacked consistent documentation of the total tube feeding volume administered. Interviews with nursing staff, the Assistant Director of Nursing, the Registered Dietitian, and the physician confirmed that the ordered volume was not fully administered and that monitoring and documentation were insufficient. The Registered Dietitian noted that the resident's tube feeding met only 88.9% of daily caloric needs and 72.8% of protein needs, and that requests to nursing staff to document total volume delivered had not been implemented. Facility policy required daily monitoring and documentation of enteral nutrition intake, but this was not consistently followed for the resident in question.